Preamble

The House met at half-past Two o'clock

PRAYERS

[MADAM SPEAKER in the Chair]>

PRIVATE BUSINESS

LONDON LOCAL AUTHORITIES (No. 2)BILL [Lords]

Read a Second time, and committed.

Oral Answers to Questions — EDUCATION

School Financing, London

1. Mr. Dowd: To ask the Secretary of State for Education what estimate she has made of the effect on average class sizes in London of the 1995–96 financial settlement for schools.

The Secretary of State for Education (Mrs. Gillian Shephard): London local education authorities will receive an extra £73 million for the 1995–96 settlement. Class sizes will depend on the way in which authorities and schools choose to spend their resources.

Mr. Dowd: I thank the Secretary of State for that reply. Will she confirm that the severity of the 1995–96 settlement, coupled with the systematic underfunding of the teachers' pay award, is nothing more than a shameful camouflage, by which the Government are attempting to revive interest in their flagging policy of encouraging opt-outs? Will she also confirm that it is a shameful attempt to try to put a few pennies in the bank for tax cuts, which will not work, at the next general election?

Mrs. Shephard: No, I will not confirm any such thing. Next year's settlement must be seen in the context of two years in which there have been generous settlements for local government. The settlement also allows an increase across the board and for education for all authorities. We expect local education authorities, by identifying priorities, by drawing on balances and by making sensible savings in central services, to accommodate the pay settlement.

Dame Angela Rumbold: Will my right hon. Friend comment on the content of a letter that has come into my possession, which is written by the education chairman of my local authority, the London borough of Merton, which is Labour controlled? She asks all her colleagues to unite in an effort to, as she puts it, "stir up aggro" among the governors and parents in the London borough of Merton against the council's "difficulties", so-called, in being able to fund education this year.

Mrs. Shephard: It is a great pity that the chairman of the Merton education committee should so waste her time.

She would be very much better employed identifying sensible priorities within her education authority so that the children of Merton do not suffer.

Mr. Don Foster: Will the Secretary of State confirm that, in London, there are almost 100,000 primary school pupils in classes of more than 30 and that the figure is set to rise unless more money is made available from the Treasury for the education service? Will she tell the House what endeavours she has made in the past few weeks to obtain more money from the Treasury and with what success?

Mrs. Shephard: I have already explained that London local authorities will receive an extra £73 million for the 1995–96 settlement. We must also remember that over the past five years, the standard spending assessments of London authorities have increased by 25 per cent. above the rate of inflation. London authorities also receive considerably more cash per pupil in their education SSAs than do other authorities. For all those reasons, I see no reason why class sizes should rise in London.

Compulsory Sport

Mr. Cyril D. Townsend: To ask the Secretary of State for Education what new initiatives she has to encourage compulsory sport within schools.

Mrs. Gillian Shepherd: The revised national curriculum for physical education places much greater emphasis on team games and competitive sport.

Mr. Townsend: Does my right hon. Friend agree with Sir Roger Bannister that we have become a nation of the contentedly unfit? Does she also agree that an element of compulsion is essential if children are to take sport seriously? What is the Department's policy on teaching cricket in schools, following our dismal and dreary performance down under?

Mrs. Shephard: I am probably one of the discontentedly unfit. My hon. Friend certainly speaks for himself. We think that competitive and team games are a very important part of a balanced PE curriculum. It will perhaps be of some comfort to my hon. Friend to learn that, in future, 14 to 16-year-olds will have to engage in two activities in the PE curriculum, one of which must be a competitive game. No doubt many of them will wish to take cricket.

Mr. Kilfoyle: How does that rhetoric square with the sales of local authority playing fields, which have been forced by the persistent cuts that the Government have made in local authority funding? What does she say also to the Dartford West high school for girls, which has had its playing fields asset-stripped and given to neighbouring grant-maintained schools for their sole use, resulting in the exclusion of 750 young girls in Dartford?

Mrs. Shephard: I wonder whether the hon. Gentleman is among the ranks of the contentedly unfit.

Mr. Kilfoyle: I was once a PE teacher.

Mrs. Shephard: The hon. Gentlemen claims that he was once a PE teacher. I am glad to hear it. He should therefore know that regulations are in place which define


the amount of playing fields that schools should have. They cannot be sold if the effect would be to reduce the area below the required minimum.

Mr. Hawkins: Does my right hon. Friend agree that, if children were encouraged to take part in compulsory sport, as Conservative Members believe should be the case, they would take a serious interest in the support of our national teams and not indulge in the kind of mindless violence that we saw so appallingly exhibited in Dublin last week?

Mrs. Shephard: It is to be hoped that that might be so. Certainly, taking part in competitive and team games helps to teach young people to work together as a team, how to co-operate and how to strive towards a common goal.

Student Loans Scheme

Mr. Pike: To ask the Secretary of State for Education what proposals she has to make changes in the operation of the student loans scheme.

The Parliamentary Under-Secretary of State for Further and Higher Education (Mr. Tim Boswell): The Government have no current plans to introduce major changes to the loans scheme, but keep its operation under review.

Mr. Pike: Does the Minister accept that the student loans scheme is seriously flawed and very unfair? Once former students reach the threshold at which they have to begin making repayments, they soon start having to pay £70 a month, when they still have low incomes and increasing commitments. Why will not the Government recognise that the scheme is a waste of time, scrap it and introduce a fairer system?

Mr. Boswell: I am afraid that the hon. Gentleman is way off beam. The average repayment currently under the Student Loans Company scheme is £14 per month. Nobody need start repayments until his income has attained at least £14,600 per annum. That is a fair provision, which should be acknowledged.

Mr. Pawsey: I hope that my hon. Friend will disregard the ill-informed comments of the hon. Member for Burnley (Mr. Pike), who clearly knows as much about the student loans scheme as I do about black pudding manufacturing. Will my hon. Friend confirm that the interest-free student loans scheme will remain and that we shall not go down the route of a graduate tax, as some Opposition Members advocate?

Mr. Boswell: I can tell my hon. Friend, who I am sure is a dab hand at making black puddings in his spare time, that we have no plans to charge a commercial rate of interest for student loans, nor have we any plans to impose a graduate tax. I can tell those Opposition Members who hanker after this nostrum to get them out of their intellectual difficulties that the likely rates of tax under those provisions would be sufficient to alarm them and, indeed, students considerably.

Mr. Bryan Davies: Does the Minister not recognise that the Student Loans Company was besieged by student complaints—35,000 before Christmas—because it could not provide students with the resources they need? What on earth is going on when the assessor, who is meant to

adjudicate between the company and student complainants, has dealt with three cases only in the past four years, has found in favour of the company on all three occasions and has been paid more than £30,000 for his pains?

Mr. Boswell: What I can say to the hon. Gentleman is that the fact that the assessor has been called in on only a limited number of occasions in the past suggests—as our evidence suggests—that the company's performance was satisfactory at its inception. The hon. Gentleman is well aware of the fact that the performance last autumn was not satisfactory.
Thanks to hon. Members on both sides of the House, Ministers and students themselves, we said that that was not satisfactory and that the company would have to deal with the situation. It has now done so, and it has also undertaken a full review of the repeat application procedure in which it is involving representatives of the Committee of Vice-Chancellors and Principals, the National Union of Students and others. That shows a responsive organisation which is anxious to help students and not the kind of caricature which the hon. Member for Oldham, Central and Royton (Mr. Davies) has already thoughtfully set out in the press release which I have.

Mr. David Martin: Does my hon. Friend recollect the scare stories that went around when the student loans scheme was introduced? It was said that the scheme would either put off students from poorer backgrounds from applying to university or prevent them staying there. That has not proved to be the case in Portsmouth. Can my hon. Friend give me some information on the national scene?

Mr. Boswell: Yes, I will readily give my hon. Friend that information. It is clear from the student income and expenditure survey which was published a year ago that, for the first time, the proportion of students from socially disadvantaged backgrounds exceeded 50 per cent. The existence of the loans scheme and the resources provided make that possible.

High School Graduation

Mr. Gunnell: To ask the Secretary of State for Education what survey she has conducted of the results of US research on the effects of the system of high school graduation on the motivation of pupils.

The Minister of State, Department for Education (Mr. Eric Forth): My right hon. Friend has conducted no survey of the results of such US research.

Mr. Gunnell: Given that there remain in our system an unacceptably high number of pupils who leave school without any tangible qualifications, does the Minister not think that there are practical lessons that we might learn from the United States system, which graduates more than 80 per cent. of its pupils from high school and encourages many of them as adults to go back to school part time to complete that qualification?

Mr. Forth: I yield to none in my affection and admiration for most things American, not least Mrs. Forth. However, the implication behind the hon. Gentleman's question is not something that we can all recognise. There are many aspects of the American system that are good, but there are many which are not so good, and that is


recognised in the United States itself. I would always he prepared to look at, and to learn from, what is good in other countries, but I would be very cautious about jumping to the conclusion that we can somehow transmute that from other countries to our system, to our benefit.

Dr. Hampson: Is my hon. Friend aware that he does not need to consider research in the United States? He simply needs to consider an independent report from the university of Leeds, which showed quite clearly that, in terms of motivation of pupils, the most important aspect was the expectations that teachers had of them. Under the Leeds system, in the primary sector—this is translatable across the country—expectations were far too low. It is now 19 years since a Labour Prime Minister, Lord Callaghan, said that there had to be an end to progressive teaching techniques and that we had to serve more the needs of industry and vocational occupations. Despite that recognition, the Labour Government did absolutely nothing about it.

Mr. Forth: My hon. Friend has put his finger on a very important matter, which has been highlighted time and time again by independent reports, not least recently by Ofsted and Her Majesty's chief inspector of schools. Too often, teachers in schools which are seen to be disadvantaged in some way, or which are in what are regarded as difficult areas, do not have sufficiently high expectations of their pupils and do not make sufficient demands on themselves—the teachers—or on their pupils. If they did, that would be a key to raising performance, expectations, staying-on rates and qualifications of the kind referred to by the hon. Member for Morley and Leeds, South (Mr. Gunnell). My hon. Friend the Member for Leeds, North-West (Dr. Hampson) is absolutely right.

School Leavers (Skills)

Mr. Nicholas Winterton: To ask the Secretary of State for Education what specific steps are being taken to ensure that pupils leaving school have the skills required by manufacturing industry.

Mrs. Gillian Shepherd: The national curriculum and the new vocational qualifications all contribute to providing pupils with the skills necessary for working life.

Mr. Winterton: Does my right hon. Friend agree with John Fraser, currently president of the Chemical Industries Association Ltd. and chairman and chief executive of Ciba plc—an international company with its headquarters in Macclesfield—who states that what manufacturing industry wants is a supply of excellent theoretical and practical scientists, school leavers with a thorough grounding in science and a general public who are scientifically literate and can appreciate the benefits of science rather than being concerned about its mysteries?

Mrs. Shephard: I am interested to hear from my hon. Friend the views of the president of the Chemical Industries Association, a group in which my hon. Friend takes a keen interest. It is important that the needs of manufacturing industry and employers in general should be addressed by the national curriculum. Manufacturing needs will be met principally through design and technology, but also through rigorous standards in science and mathematics. We are also devoting resources to

developing the use of information technology, which again is of clear relevance. What matters most is that standards should be rigorous.

Mr. Blunkett: Given that industry is dependent on young people being literate and numerate, is this not entirely the wrong moment to be cutting investment in our education service? Will the Secretary of State this afternoon give the House and the country a pledge that, following her statement in Leicestershire last Wednesday, she is prepared to listen to what is happening in schools and colleges and to do what her predecessor—the present Chancellor of the Exchequer—did three years ago and go to the Cabinet and argue for further investment to meet the teachers' pay increase? Would that not avoid a reduction in standards, a reduction in opportunity and a reduction in the literacy and numeracy which our industry requires for the future?

Mrs. Shephard: Perhaps I can reassure the hon. Gentleman that we are not cutting investment in education. As I made clear earlier, next year's settlement allows for an increase across the board. The total of more than £28 billion is a considerable investment in the future of our young people. It is time that the hon. Gentleman stopped scaremongering in this way, and looked at the framework for standards and rigour, which is hacked by £28 billion of investment.

Grant-maintained Schools

Mr. Peter Atkinson: To ask the Secretary of State for Education how many grant-maintained schools there are in the north of England.

The Parliamentary Under-Secretary of State for Schools (Mr. Robin Squire): There are 137 grant-maintained schools in the north of England.

Mr. Atkinson: Will my hon. Friend confirm that, out of the 900 schools inspected so far, just 9 per cent. are grant-maintained schools, yet out of the 52 schools identified in the "best improvers" category, 14 were grant-maintained? Does that not show that, above all, the argument is about quality? Is it not a pity that more parents in the north have not had an opportunity to vote on the issue?

Mr. Squire: My hon. Friend has stumbled across an interesting statistic. It is fairly well known that many of our best schools have become self-governing. What is less well known is that many of our most improving schools have also become self-governing, and the figures which my hon. Friend has given clearly underline that point. I would simply add that that will only increase the attraction of those schools to parents—including, of course, parents who are also Labour party activists.

Mr. Campbell-Savours: The reorganisation in my constituency involves Keswick school. With that in mind, will the Minister tell me whether grant-maintained schools have advantages in being able to raise money for capital projects over and above other similar schools which are not grant-maintained? If they do have advantages, why, in principle, should they?

Mr. Squire: The answer is a little complex. It is not true to say that grant-maintained schools may borrow formally. They can certainly look to outside interests which may be interested in making various arrangements


with them, as indeed can an LEA school. Of course, an LEA can borrow significantly greater sums. [Interruption.] If the hon. Member for Sheffield, Brightside (Mr. Blunkett) would sit quietly for a moment, he might hear something useful. In 1993–94, nearly half of all capital expenditure by local authorities on schools was funded other than by Government-approved borrowing. That is why grant-maintained schools must have access to other forms of funding, including a reasonable capital allocation.

Sixth Forms

Mr. Colvin: To ask the Secretary of State for Education what is the trend in the formation of sixth forms in comprehensive schools; how this compares with the development of sixth form and tertiary colleges; and if she will make a statement.

Mr. Boswell: Schools continue to bring forward proposals for the addition of sixth forms. All such proposals which come before my right hon. Friend are carefully considered on their merits in the light of our published criteria. Sixth form and tertiary colleges continue to thrive.

Mr. Colvin: I acknowledge that the introduction of local management of schools and grant-maintained status have greatly added to choice and diversity in education. Does my hon. Friend agree that comprehensive schools must think carefully before seeking to add sixth forms to their schools, especially when sixth form and tertiary colleges already exist locally and where those have a campus atmosphere more appropriate to sixth form education?

Mr. Boswell: I certainly agree with my hon. Friend that comprehensive schools should consider carefully the importance of making such a proposal, which would be judged against our published criteria. Those include whether there is a basic need for new provision and, if not, whether the viability of existing good-quality provision would be adversely affected if the proposal were approved. A school would have to satisfy us on that criterion, among others, before we took a favourable decision.

Mr. Rooker: Does it remain part of the Government's published criteria that, in terms of value for money and educational opportunity, a sixth form should not have fewer than 150 pupils? If so, why have the Secretary of State and her predecessor continued to approve new comprehensive school sixth forms with fewer than 150 pupils, which is bound to damage choice and opportunity for those pupils?

Mr. Boswell: It may be for parents and pupils to determine whether choice and opportunity are removed. The criteria state specifically that the provision should be of sufficient size and quality to deliver a reasonably wide-ranging curriculum, and we consider the inspectorate's observations in deciding on a proposal. So the hon. Gentleman's concerns are not overlooked. However, there is no precise criterion, and we judge each case on its merits.

Mr. Patrick Thompson: Given the popularity and success of the Government's recent reforms affecting further education, will my hon. Friend bear in mind, when

considering the best way to fund schools in the future, the fact that the funding of further education colleges is transparent while the funding of schools in the secondary sector is not?

Mr. Boswell: I hear what my hon. Friend says, but it may interest the House to know that, over the past quinquennium, there were 267,000 pupils aged 16 to 18 in the maintained sector and 471,000 pupils in FE and sixth form colleges, so the rate of increase in further education has been markedly sharper than in sixth forms.

Discretionary Awards

Mr. Hain: To ask the Secretary of State for Education what monitoring she plans to undertake of the discretionary awards system.

Mr. Boswell: Discretionary awards are the responsibility of local authorities. The Department will continue to collect a range of relevant statistical and other data from them.

Mr. Hain: Is not the discretionary award system now an absolute shambles? Legal, dance and drama, music and many other categories of student have no chance whatever of getting a discretionary award because of the Government's cuts in funding. The Minister must not insult the intelligence of the House or of students by pretending that local education authorities can bridge the gap, when he and his Government are savaging local education budgets.

Mr. Boswell: I am not sure whether the hon. Gentleman feels that his intelligence will be insulted if I invite him to consider the facts. When the Gulbenkian Commission, which is not under Government control, considered that matter, it projected an increase of about 20 per cent. in the total number of discretionary awards between 1990–91 and 1993–94, a 32 per cent. increase in further education courses and an increase in expenditure of 14 per cent. in real terms in the same period. The fact that there is worry about local provision in some local education authorities should not be taken by the hon. Gentleman as an excuse for a diatribe against a system that we continue to fund, and which is not failing.

Mr. Harry Greenway: Does my hon. Friend agree that many local authorities, especially Labour and Liberal Democrat controlled authorities, do not pay proper attention to the discretionary awards system, and that young people miss out as a result in terms of course, career and their future? Will he seek to do something about it?

Mr. Boswell: I do hear what my hon. Friend says and I respect his expertise in that matter. All the local authority associations with whom we have discussed the matter want very much to continue their discretion; the problem is that some of them, wilfully or for whatever reason, choose not to exercise it and thereby deprive young people of the resources that we make available with that purpose in mind.

Class Sizes

Mr. Milburn: To ask the Secretary of State for Education if she will make a statement on class sizes in schools.

Mr Robin Squire: Class sizes are rising slightly, as pupil numbers increase. At the same time many schools are raising pupils' standards of achievement.

Mr. Milburn: Is the Minister aware of the substantial worries of parents, teachers and governors in County Durham schools about the impact of his funding policies on class sizes and on educational standards?
With more than 1 million primary school pupils already being taught in classes of over 30, is not teaching becoming less a means of offering children a valuable learning experience and more a matter of crowd control? What sort of future is that for our children?

Mr. Squire: First, the average class sizes for both primary and secondary schools in Durham are close to the national averages, which are certainly not too high.
Secondly, one might have thought, from listening to the hon. Gentleman's question, that the position in 1979 when the Conservatives came to power was not about 400,000 pupils greater than the figure that the hon. Gentleman gave for those in classes of over 30.

Sir Mark Lennox-Boyd: When considering class sizes in Lancashire, does my hon. Friend agree that the behaviour of the local education authority, which puts the interests of maintaining its centralised bureaucracy above that of maintaining or reducing class sizes, will only encourage more parents to consider grant-maintained status?

Mr. Squire: My hon. Friend echoes some of the comments of the Audit Commission about too large bureaucracies in local government, and his argument is a good one. I expect Lancashire education authority, as I do every other education authority, to review all its expenditure and to examine it closely before it considers cutting teachers at the sharp end, and to look more closely at the administrators in county hall.

Accessibility Audit

Mr. Corbett: To ask the Secretary of State for Education what progress has been made on the accessibility audit of primary and secondary schools.

Mr. Forth: Local education authorities and the Funding Agency for Schools are required to provide the Secretary of State in May this year with information about the accessibility of schools to pupils in wheelchairs. The Department issued guidance on that exercise on 6 January.

Mr. Corbett: I thank the Minister for that reply. What plans does he have to extend that audit to further and higher education? When all those audits are completed, and they confirm what we know already—that most primary schools, most secondary schools and most colleges of further and higher education are far from accessible to people with disabilities—will his Department make new and extra money available to increase that accessibility?

Mr. Forth: What we want to do first is to consider and assess the results of the first tranche of information, which will be important in setting the scene. I hope that we shall be able to build on that in terms of discovering where we most need to ensure better accessibility.
I am sure that the hon. Gentleman and the House accept that we cannot and do not necessarily want every school to have wheelchair access. It is a matter of establishing priorities. I believe that a satisfactory mechanism already exists in further and higher education to tackle the problem of access, but we shall constantly look to that sector to bring forward its further proposals. I hope, some time in the near future, to be able to announce a new project to improve accessibility in our schools. There is a lot going on in that area and the survey results will be the first step in a number of successive measures to he taken.

Mr. Congdon: Given that the Spastics Society produced a report showing that many schools could provide accessibility to people with disabilities relatively cheaply, does my hon. Friend agree that it is about time that local education authorities gave accessibility of schools the priority that it so richly deserves?

Mr. Forth: Yes, and the schools themselves must make accessibility a priority. Each school must now have a published policy on its treatment of special educational needs and that, together with the special needs code of practice, makes me believe that we should see a lol of progress in this area which, in the past, has been somewhat neglected by schools and authorities alike.

Spoken and Written English

Mr. Brandreth: To ask the Secretary of State for Education what recent representations she has received concerning standards of spoken and written English; and if she will make a statement.

Mrs. Gillian Shephard: I regularly receive letters from parents and others concerned about standards of English. I share their concern.

Mr. Brandreth: Does my right hon. Friend recognise that English is the richest and the most versatile of all the living languages, and increasingly the world language of business and commerce? Does she further recognise that employers in my constituency are concerned that young people are coming onto the job market without a sufficient command of written and spoken English? Does she believe that that issue must be addressed not simply in schools and colleges, but by the media and by the employers themselves?

Mrs. Shephard: People are judged by whether they can express themselves clearly and employer organisations constantly say that good communication skills are important for all areas of employment. We must ensure that all pupils are equipped with the skills that they need, and the combination of the revised national curriculum with testing and regular inspection will ensure that that happens.

Ms Glenda Jackson: If the Secretary of State is concerned that the standards of spoken and written English should improve and genuinely believes that individuals are judged on their ability to use the English language well, why has she not waged a stronger defence to prevent the cutting of section 11 funding—a comparatively small amount of the overall education budget—which has shown quite extraordinary returns,


particularly in inner urban areas, where children who do not have English as a first language have improved their use of our language?

Mrs. Shephard: I certainly agree with the hon. Lady that the use of section 11 funding for the teaching of English—especially when it is a second language—has been extremely effective, particularly in many of our inner cities. That is why I am delighted that the Government announced the doubling of section 11 funding in November.

Discipline

Sir Fergus Montgomery: To ask the Secretary of State for Education what measures she is taking to help schools enforce firm discipline.

Mr. Forth: Last May guidance on pupil behaviour and discipline was sent to all schools, as part of the "Pupils with Problems" pack. The guidance aims to help schools maintain and improve discipline. In September 1994 the Department published an anti-bullying pack to help schools combat bullying.

Sir Fergus Montgomery: Does my hon. Friend admit that there is an awful lot of media hype about schools being out of control and does he agree that the recent report of Her Majesty's chief inspector of schools gives the lie to that? Does he agree also that parents have some responsibility for helping to improve discipline in our schools?

Mr. Forth: I am very grateful for my hon. Friend's comments. He is right to point out that all recent impartial reports by the inspectors demonstrate that the standard of behaviour in the majority of our schools is good or very good.
My hon. Friend's other point is equally valid. One of the great difficulties that teachers now face in seeking to exercise discipline in the classroom is that they do not receive sufficient support from the parents. We cannot expect teachers to do everything with regard to disciplining pupils; parents must also play a full role.

Mr. Blunkett: In the light of that reply and given the importance of discipline to a learning environment, what advice would Ministers give to a teacher who manages a class of more than 40 students? Would they give the same advice to the Prime Minister, who cannot manage a class of 22?

Mr. Forth: The list of measures and sanctions available to anyone having difficulty with disciplining a group of people include interruption of break or lunchtime privileges, detention, withholding privileges such as participation in trips, completion of assigned or additional written work and carrying out a useful task. [Interruption.] I hope that anyone involved in bringing discipline to bear will find my list helpful.

Truancy

Mr. Amess: To ask the Secretary of State for Education what action she is taking to combat truancy.

Mr. Forth: The Department is currently supporting locally-devised projects to a value of some £14 million in more than 80 English local education authorities under the truancy and disaffected pupils programme of the grants

for education support and training scheme 1994–95. In December, we announced further support for some 90 projects in 1995–96 to a value of £15.6 million.

Mr. Amess: Is my hon. Friend aware that during my present tour of every school in my constituency, the subject of truancy has been mentioned, and that Basildon heads will be mentioning it to my right hon. Friend the Secretary of State when they meet her on 8 March? As GEST expenditure forms a considerable investment of public funds, can my hon. Friend reassure Basildon heads that the present schemes are working?

Mr. Forth: My hon. Friend, as ever, raises an important point which concerns the Secretary of State and myself constantly. I hope that he agrees that our considerable investment in those projects has great potential to show enormous benefit, particularly when the team of consultants that we have asked to conduct an independent survey of the projects report to us later this year. We want them to evaluate the projects to find out how best to deal with the difficult problem of truancy and then to disseminate that as good practice to help my hon. Friend's head teachers, who I know will want to work with him in dealing with that extremely difficult problem.

Teacher-pupil Ratio

Mr. Steen: To ask the Secretary of State for Education what is the Government's policy on the optimum number of pupils per teacher in (a) primary and (b) secondary schools; and if she will make a statement as to how far this policy has been achieved.

Mr. Robin Squire: Our policy is that schools should be free to organise classes and deploy teaching staff within the resources available as they judge appropriate.

Mr. Steen: Is the Minister aware that Devon county council has told schools in my constituency and throughout Devon that they will have to cut the number of teachers, increase class sizes and get rid of the choice of subjects in schools because they can not afford to pay? Could my hon. Friend please tell me that this is part of a scurrilous campaign by the Liberal county council to terrify parents and to make people fear that cuts will be made when the money could be taken from elsewhere in the budget?

Mr. Squire: I know that my hon Friend's attention to his own LEA's detailed expenditure will be greater than mine. It is open to his local education authority and to some of the others we have already mentioned this afternoon to choose priorities in such a way that they do not damage the quality of education in the schools in their area. If his authority is not doing that, it must be judged by the standards that it sets. The Government have determined increased expenditure for education; it is up to authorities, if they so wish, to choose other priorities.

Mr. Ronnie Campbell: A few weeks ago I asked a question for written answer about teacher ratios in the local education authority in Northumberland. There has been an enormous increase in teacher ratios, and last week teachers in Northumberland told me that, if the cuts go ahead and teachers are lost, there will be another


enormous increase in teacher ratios there. What will the Minister do about that, or is he just in charge of the nursery school and not education?

Mr. Squire: A good try, I suppose. The hon. Gentleman has heard successive Ministers say from the Dispatch Box that how schools organise themselves must be a matter for individual schools. He may also have heard a moment ago, in response to an earlier question, that I drew attention to the fact that while numbers of classes over 30 in primary schools are indeed rising slightly to just over a quarter, that compares with a figure of 35 per cent. when the Government that he would have supported left office.

Mr. Riddick: Following the Audit Commission report which showed that local authorities took on an extra 90,000 staff between 1987 and 1993, does my hon. Friend agree that local education authorities should be trying to reduce spending on central bureaucracies rather than spending on schools?

Mr. Squire: My hon. Friend, who speaks with considerable knowledge of education matters, is absolutely right. [Interruption.] Although Opposition Members do not like hearing the truth, they are going to hear it. It is important for an authority to examine the whole range of its services, and in particular to try to protect its teaching force as far as possible.

Oral Answers to Questions — PRIME MINISTER

Engagements

Mr. Hutton: To ask the Prime Minister if he will list his official engagements for Tuesday 21 February.

The Prime Minister (Mr. John Major): This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

Mr. Hutton: In the light of today's announcement that the chairman of the National Westminster bank has awarded himself a 35 per cent. pay increase, and the news that the seven wise men appointed by the Confederation of British Industry to provide new guidelines on executive pay have themselves shared more than £4 million in pay and tax this year, does the Prime Minister think that it is time that he joined the British public in condemning those latest examples of executive greed in Britain's boardrooms?

The Prime Minister: As the hon. Gentleman will know, when excessive and unjustified pay increases have been agreed I have condemned them—and condemned them from the Dispatch Box on a number of occasions. Where the hon. Gentleman and I disagree is on whether, in the private sector, it is right for the Government to institute a pay policy both at the top—as the hon. Gentleman would clearly like—and with minimum pay controls at the bottom, as the Labour party would like.

Mr. Evennett: To ask the Prime Minister if he will list his official engagements for Tuesday 21 February.

The Prime Minister: I refer my hon. Friend to the answer I gave some moments ago.

Mr. Evennett: Does my right hon. Friend agree that neighbourhood noise nuisance and noise pollution are a

real and growing problem in today's society? Will he urge our right hon. Friend the Secretary of State for the Environment to speed up his inquiry into the problem, and advance positive suggestions for its alleviation as soon as possible?

The Prime Minister: I agree with my hon. Friend that noise pollution is a nuisance. I am sometimes inclined to think that it is a particular nuisance at 3.15 pm on Tuesdays and Thursdays. [Interruption.]

Madam Speaker: Order.

The Prime Minister: I have no doubt about the extent of nuisance that is caused to many people, and the Department of the Environment is examining that now. I hope that we shall have some proposals on which to negotiate in the next few weeks, and I shall be pleased to hear the views of not only my hon. Friend, but anyone else who has views to offer on the issue.

Mr. Blair: Will the Prime Minister confirm as a matter of fact that, since the internal market reforms in the health service, the costs of its adminstration have risen by over £1,000 million?

The Prime Minister: The right hon. Gentleman will know—for the Socialist Health Association will have told him—that improved internal adminstration is necessary, not least because of the lack of financial control that existed before.

Mr. Blair: Is not the problem the difference between what Ministers say about the health service and people's experience of it? [Interruption.] Conservative Members would do well to listen to their constituents.
Is not the problem the fact that people who see wards, and sometimes whole hospitals, facing merger or closure would prefer that £1,000 million to be spent not on more accountants and company cars but on beds, nurses and patient care?

The Prime Minister: I am intrigued that the right hon. Gentleman has referred to what the public say. He may have seen the recent "British Social Attitudes Survey", which makes it clear that, since our reforms, the number of people satisfied with the national health service has leapt by another 20 per cent., and that nine out of 10 people think that the national health service is satisfactory or better.
He may also have seen the recent survey by doctors, which found that the overwhelming majority felt that health needs were being better met under the reforms than previously, and that a 2:1 ratio felt that competition among hospitals had improved service. That is the view of the public who use the service and of the doctors who run the service, both of whom have a greater and more in-depth knowledge of it than the right hon. Gentleman.

Mr. Blair: I have just one question for the Prime Minister: if the service is so good, why did the deputy chairman of the Conservative party ask before Christmas, in the interests of the Conservative party, for zero media coverage of the health service?

The Prime Minister: I want a lot of coverage and I shall tell the right hon. Gentleman why—so that we can refer to the 8 million patients in total who are treated each year, to the 119,000 cataract operations, to the 333 million free prescriptions, and to the growth of the national health


service over the past few years. I might also remind the right hon. Gentleman not only that more people are treated and that they are better treated, but that a wider range of service is available to the NHS today than ever before. Before he and his colleagues doubt the Government's commitment to the health service, they should consider the additional funding that we have provided, and recall that Labour were the only Government ever to cut resources to the NHS.

Mr. Fabricant: To ask the Prime Minister if he will list his official engagements for Tuesday 21 February.

The Prime Minister: I refer my hon. Friend to the answer I gave some moments ago.

Mr. Fabricant: My right hon. Friend will know that I am a member of the Select Committee on National Heritage and that it is considering the future of the British film industry. Is my right hon. Friend aware that Mr. Ken Loach, an English director, is today premiering his new film, which champions the cause of nationalisation on behalf of Labour's Defend Clause IV group? Is my right hon. Friend aware that that film will be a nostalgic romp, looking at the nationalised car industry and the nationalised steelyards, and that it will possibly feature a romantic look at Red Robbo? Will my right hon. Friend be nominating that film for an Oscar?

The Prime Minister: I very much doubt that I will be nominating the film for an Oscar, but it seems to be the sort of film that deserves a wide circulation. There is no doubt that the right hon. Member for Sedgefield (Mr. Blair) is right to wish to abolish clause IV from his party's constitution. The only matter of surprise is that so many people in the 1990s still disagree with that obvious and worthy cause. The question is whether the right hon. Gentleman will succeed, and the answer is that of course he will, because he will have the support of the unreconstructed trade unions in doing so.

Mr. Salmond: May I offer the Prime Minister a chance actually to do something about fat cat salary increases? Some thousands of small shareholders in British Gas, supported by the staff, are going to the annual general meeting in two months' time with a motion to cut the outrageous pay increase of Mr. Cedric Brown. Does that motion carry the Prime Minister's support or not?

The Prime Minister: I have made it absolutely clear to the hon. Gentleman and to others that, if one puts an industry in the private sector, it must make its decisions in the private sector. That applies to British Gas, as to other companies.

Mr. John Greenway: To ask the Prime Minister if he will list his official engagements for Tuesday 21 February.

The Prime Minister: I refer my hon. Friend to the answer I gave some moments ago.

Mr. Greenway: Does my right hon. Friend agree that the United Kingdom livestock industry leads Europe, both in terms of the quality of meat production, and in standards of animal welfare? Will his Government continue to press for higher welfare standards across Europe and, at the same time, uphold the rule of law in

Britain, so that farmers and haulage firms can go about their legitimate business, free from the constant disruption of animal rights activists?

The Prime Minister: I agree with both my hon. Friend's propositions. There is no doubt about the need to maintain law and order, whatever the cause, where the law has been broken. As I have said, legally and practically, we need to work at Community level if we seriously want to bring the standards of animal welfare across the European Union up to the standards in this country. That is what my right hon. Friend the Minister of Agriculture, Fisheries and Food is seeking to do, and I hope and believe that he will be successful.

Mr. Matthew Taylor: To ask the Prime Minister if he will list his official engagements for Tuesday 21 February.

The Prime Minister: I refer the hon. Member to the answer I gave some moments ago.

Mr. Taylor: What advice does the Prime Minister have for the governors of schools such as St. Agnes in my constituency which has seven teachers to cover the seven age groups in the school and who are now having to decide whether to make one of those staff redundant because of the failure to meet the teachers' pay increase? Should the school engage in those redundancy procedures now, or should it wait a few weeks to see whether the Secretary of State for Education comes up with the goods in her argument with the Chancellor of the Exchequer?

The Prime Minister: I think, perhaps, the first thing the governors should do is to examine whether their education authority has its priorities right in determining where the money that has been allocated to it has gone. Then, they might look at how many surplus places there might be in that education authority. I suggest then that they look at the balances in the education authority. When and if they are absolutely satisfied that the money is being spent properly, perhaps they can assure the hon. Gentleman of that. Nothing that the hon. Gentleman has said has convinced me that that is so in this case.

Sir James Kilfedder: Is it not manifestly unfair and totally undemocratic that I was not consulted, briefed or spoken to at any stage during the drawing up of the draft document? Does not the Prime Minister feel that, in view of the involvement through Dublin of the Social Democratic and Labour party in the drafting of the document and in view of the fact that Her Majesty's Government, through their representatives, have been talking to the political wing of the terrorists, that this is a contemptuous way to deal with Unionist Members of Parliament? Surely, when the Prime Minister speaks directly to the people of Northern Ireland, they will remember this.

The Prime Minister: There has been widespread consultation. It is not the case that other parties have been involved in the drafting of the document that is to be produced. As my hon. Friend will know, the document is for consultation and consideration with my hon. Friend, with representatives from all the political parties in the House and with people right across Northern Ireland. What we are seeking to do, as we were asked to do by the political parties, is to set down some ideas for consideration, discussion and negotiation between the


political parties. When and if they are able to reach agreement, we will carry the matter forward. The objective that I have is the same as that which I know my hon. Friend has and that is to ensure that what has been thus far a ceasefire is able to be turned into a permanent peace for the well-being of all the people in Northern Ireland, including my hon. Friend's constituents, whom he represents so well.

Mr. Maginnis: Does the Prime Minister agree that a well-directed and well-planned approach towards a practical solution to Northern Ireland's problems would be better than a never-ending debate about some sort of theoretical process—the sort of debate that has gone on for 10 years since the signing of the Anglo-Irish Agreement—which did not deliver peace, stability and reconciliation? Will the Prime Minister undertake to read and to study my party's document entitled "A Practical Approach to Problem Solving in Northern Ireland", with a view to arriving at a solution and not continuing this theoretical and futile debate for yet another 10 years?

The Prime Minister: I share with the hon. Gentleman the wish not to have a futile debate. The way to ensure a constructive debate is to come together and discuss the ideas that are about and that are on the table. Ideas have

been produced at the request of the political parties. As it happens, I received the document in the hon. Gentleman's hands last evening, and I have read it this morning. I have no doubt that other documents will be produced. One has already been provided by the leader of the Democratic Unionist party. Further documents may be prepared.
What is necessary; what the obligation owed, I believe, to the people in Northern Ireland who want a permanent peace, is for all of us—the Government, the hon. Gentleman, other hon. Members and the people of Northern Ireland—to make sure that those matters are examined, discussed, considered, and decisions reached that will enable us to move forward into a permanent peace. That is what I wish to seek, and my mind is open to the right mechanism to ensure that we achieve it. But what I am determined is that we do seek to move forward to try and ensure that the chance that is in our hands—we may not be able to hold it—that the chance of peace that is in our hands should not slip away because we are not prepared to examine the matter, to talk about the matter, to consider the matter, and to reach the conclusions that the hon. Gentleman wishes to see reached.

NEW MEMBER

The following Member took and subscribed the Oath:

James Donnelly Touhig, Esq., for Islwyn.

Points of Order

Mr. Bob Dunn: On a point of order, Madam Speaker. There are two related aspects. I am concerned that the House of Commons was seriously misled this afternoon by the hon. Member for Liverpool, Walton (Mr. Kilfoyle), who raised a Dartford constituency matter during Education Questions without giving me notice of his intention to do so. He stated that the Dartford West secondary school for girls had been stripped of its playing fields. That issue was open for public consultation until 11 February, and no decision on it has yet been issued by the Department for Education. Will you require the hon. Gentleman to withdraw his statement and to apologise?
Secondly, may I make you aware, Madam Speaker, that the hon. Gentleman visited that school, which is in my constituency, last Thursday and did not give me any intimation or message of his intention?

Madam Speaker: These are not points of order.

Mr. Peter Kilfoyle: I see nothing to withdraw.

Madam Speaker: That being the case—

Mr. George Foulkes: On a point of order, Madam Speaker.

Madam Speaker: Order. Just a moment. Let me deal with one question at a time. Hon. Members are too anxious to be heard in the House.
The hon. Member for Dartford (Mr. Dunn) is telling me that there is an untruth in the allegation made here. If he would like to table an early-day motion or use the Order Paper, that is what he must do if the allegation made by the hon. Member for Liverpool, Walton (Mr. Kilfoyle) is incorrect.
As I have often said in the House, when hon. Members visit another hon. Member's constituency, it is only right that they give him or her notice of doing so. That is a common courtesy and is the way in which we behave in the House. Hon. Members inform me when they come to my constituency, and they are very welcome, but they always let me know in advance when they are going to be there.

Mr. Foulkes: I apologise for rising too soon earlier, Madam Speaker. During the first two or three Parliaments that I was a Member of the House, statements were regularly made to the House after European Council meetings, whether they were meetings of ECOFIN or the Fisheries or Agriculture Councils. The Minister who had attended the meeting made a statement and was open to question. For the past few months—indeed, for the past few years—there have not been regular statements, which means that the Government are increasingly unaccountable to the House for their actions at European Council meetings.
For example, last week I know that Baroness Chalker—

Madam Speaker: Order. The House does not have time to listen to the hon. Gentleman's examples. I understand his point. He is asking for Government statements after various meetings have taken place. As the House knows, and as the hon. Gentleman knows only too well, I have no authority to require a Minister to make a

statement at the Dispatch Box. It is for the Leader of the House to determine when statements are made, and the matter can be put to him during Business Questions. The hon. Gentleman is often on his feet during Business Questions and I shall look for him on Thursday, should he care to put the matter to the Leader of the House—that is without commitment.

Mr. Tim Devlin: Further to the earlier point of order relating to—

Madam Speaker: Order. There is no further point of order once I have dealt with a matter. We could go on for ever. If it is a new point of order, I shall listen to it.

Mr. Devlin: It is a separate matter, Madam Speaker. Is it not the convention of the House that, if an hon. Member intends to refer to another in a debate, he should let that hon. Member know? That was not the case last night, as you will see from column 82 of Hansard.

Madam Speaker: I have in my office a sheaf of statements that hon. Members can collect. I am weary of making statements about the way in which hon. Members should behave towards each other. I have made two or three such statements in the past six months. Hon. Members should know how to behave with common sense and courtesy, but, if they need reminding, let them come to my office, where I shall give them a file of the statements that I have made to the House.

Mrs. Alice Mahon: On a point of order, Madam Speaker. Have you seen a report in today's Daily Mirror on the misnamed "Commissioner for the Protection of Trade Union Rights"? It appears that £1.9 million of taxpayers' money has been spent on 16 cases of trade union bashing. Has the Secretary of State for Employment, or even the Prime Minister, said that he intends to explain to the House that abuse of public money?

Madam Speaker: I have had no indication that any Minister is seeking to make a statement today on any matter.

Mr. Patrick McLoughlin: On a point of order, Madam Speaker. I am grateful for your having told us about the sheaf of statements in your office. What power do you have to act when hon. Members ignore your advice by not informing other hon. Members when they go to their constituencies, especially if they are going in an official capacity such as that of Front Bench spokesmen? It seems that your advice is being ignored despite your having warned us about this previously.

Madam Speaker: I expect hon. Members to behave with a degree of common sense. I am the servant of the House, and the House gives me authority to carry out various instructions. If the hon. Member would care to refer the matter to the Procedure Committee, the Committee may make a recommendation giving me some authority in these matters, and it might not be a bad idea if it did just that.

Mr. Tony Banks: On a point of order, Madam Speaker. Your rulings on such points of order are clearly of great importance because they set precedents. I hold many Labour party meetings around the country. Are you in effect saying that, if an hon.


Member is going to hold a party political meeting in another hon. Member's constituency, he should give notice to that hon. Member about that fact?

Madam Speaker: I should have thought that that was pretty reasonable. Only this week I had a letter from a Member of the Government Bench, telling me that he is coming to my constituency for a political meeting. I doubt that his party will win the seat from me, but I said that I would be delighted to see him. I think that hon. Members should be informed, irrespective of what the visit is for.

Mr. Jeff Rooker: On a point of order, Madam Speaker. Notwithstanding your point about courtesy, it could be a mistake to take the matter to the wrong conclusion. Members of Parliament do not have proprietorial rights over their constituencies. We do not own our constituencies and there must be no barriers to prevent Members of the United Kingdom Parliament from going on fact-finding missions anywhere in the country. They should not require permission from any other Member of Parliament to do so.

Madam Speaker: The hon. Gentleman and the House must not run away with the idea that permission is required. It is simply a matter of courtesy to tell the hon. Member concerned. It is right that a Conservative Member who comes to my constituency to hold a political meeting should let me know about it. The hon. Gentleman might feel the same. There is nothing wrong with that; it is common sense and courtesy. I would do the same if I visited another hon. Member's constituency.

Mr. Ian Bruce: On a point of order, Madam Speaker. I hesitate to raise this point of order. Apparently, you have upset one of my constituents who is one of your greatest fans. I have had a letter from Mr. Paul Cooper of Swanage telling me that you told us last Thursday—you have confirmed this in a letter to us today—that we would commemorate the 50th anniversary of the end of world war two. Mr. Cooper tells me in his letter that his war did not end until August and that this May, we shall celebrate the victory in Europe—

Madam Speaker: Order. This is not a point of order for me. I made a comprehensive statement last week and questions were raised during Business Questions with the

Leader of the House. Everyone knows precisely what we are commemorating—the ending of both wars—and it will be done properly.

Mr. Brian H. Donohoe: On a point of order, Madam Speaker. Can you give me some advice? Given that I come down to Westminster every week, should I write to the right hon. Member for Westminster, North (Sir J. Wheeler) before I come here?

Madam Speaker: I find that a totally ridiculous waste of the House's time. There is no common sense in that ludicrous point of order.

Several hon. Members: rose—

Madam Speaker: Order. I am taking no more points of order now. We have business to do here.

Mr. Anthony Steen: rose—

Madam Speaker: Has the hon. Gentleman just decided that he has a point of order?

Mr. Steen: No. I wanted to be helpful to you, Madam Speaker, because I have listened for some weeks to the exchanges between you and Opposition Members about what should happen when an hon. Member visits another hon. Member's constituency. I chose not to raise a point of order because I did not want to trouble the House or take up time. However, having heard the exchanges today, I want to ask for your help.
When the right hon. Member for Chesterfield (Mr. Benn) came to my constituency two weeks ago, he held a public meeting in the civic centre in Totnes which attracted 700 or 800 people—[HON. MEMBERS: "Hear, hear!"]—which is the entire membership of the Labour party in South Hams. He did not have the courtesy either to write to me or to tell me about his visit beforehand or afterwards. Could you, Madam Speaker, do more than just criticise hon. Members? Could you do something to prevent hon. Members who misbehave in this way from attending the House?

Madam Speaker: If the hon. Gentleman had been listening to my earlier response, he would know that I suggested to the hon. Member for West Derbyshire (Mr. McLoughlin) that he might like to refer to the Procedure Committee whether I might have some authority to take action. I am surprised about the incident to which the hon. Gentleman referred. I have always found that the right hon. Member for Chesterfield (Mr. Benn) has very good parliamentary manners. The hon. Gentleman may be rather sorry that he has raised the matter today, because he has given the meeting greater publicity than he may think it deserves.

Television Sport (Public Access)

Mr. Bruce Grocott: I beg to move,
That leave be given to bring in a Bill to amend the Broadcasting Act 1990 to provide that listed national sporting events, namely the F.I.F.A. World Cup Finals, the F.A. Cup Final, the Scottish F.A. Cup Final, the Wimbledon Finals, the Olympic Games, the Derby, the Grand National and Test Matches in England continue to be available on terrestrial television, and for connected purposes.
My Bill will provide for major sporting events to continue to be available on the main television channels. Millions of people—I freely admit to being one of them—enjoy watching sport on television. If viewing figures are anything to go by, sporting events are very popular. Last year, the grand national attracted 17 million viewers, the World cup finals were watched by 13.5 million people, the F.A. cup was watched by 12 million people, 11 million people watched the Olympics and perhaps the most spectacular viewing figure of all—I am not sure that everyone would call it a sport, but many fellow citizens do—was 24 million people, getting on for half the adult population, who watched Torvill and Dean at the winter Olympics.
The appeal of sport on television, lest I be accused of simply pleading sporting interest, goes far beyond people who are sports enthusiasts. When the grand national is on television, it is discussed before the race, during the race and after the race in pubs, clubs and households everywhere. Indeed, major sporting events of the past are often remembered even generations after they occurred. Who could forget the 1953 Stanley Matthews cup final, which is remembered 42 years afterwards? Whether one supported Bolton or Blackpool, the memories are strong.

Mr. Dennis Skinner: What was the score?

Mr. Grocott: Three-two. [HON. MEMBERS: "No, it wasn't."] It was 4:3. [Laughter.] Who could fail to remember the last moments of the 1966 World Cup final? Even the words of the commentator, "They think it's all over—it is now", are almost part of national memory. Such events are more than just sporting events, as are other triumphs in sport, whether by Coe, of whom some hon. Members may have heard, Ovett or Daley Thompson.
More recently, although people do not always describe it as a major sport—it has been popularised by television—who could forget the match between Dennis Taylor and Steve Davis, when Dennis Taylor won in the early hours of the morning on the last ball of the last frame? Millions of people stayed up to watch that event. Those events are part of our national life, they enrich our national life, they sometimes give us unforgettable memories, they amuse us and they entertain us.
What has been happening recently? In practice, there has been a steady loss of events from the main terrestrial channels. It makes a pretty long list. In golf, for example, the Ryder cup, ironically having been popularised by the BBC, is being lost, as is the United States PGA tournament, one of the four major golf tournaments. One-day cricket internationals in the United Kingdom are going and the Benson and Hedges cricket matches are going. We cannot even see the highlights of test matches overseas, let alone any live coverage. Most important of

all, from our national sport with its huge popularity football at its highest level—the Premier league—was lost to ITV and has now gone to Sky.
Rumours abound about further losses of sporting events from terrestrial channels. It is no secret that Sky has been interested in acquiring the finals of Wimbledon, and there are rumours that cable television wants to take over coverage of the Endsleigh league. There is no doubt that the cable and satellite companies are interested in acquiring major sporting events and, obviously, increasing their number of subscribers by so doing.
People may criticise my Bill by saying that free-market forces somehow act in the magical interests of all viewers, or they may ask why we should worry because it is only a matter of time before satellite and cable channels are available to everyone. There is a short answer to such an allegation—those suggestions are rubbish.
Let us be clear about how many people watch major events once they are transferred to satellite and cable channels. The truth is that only a fraction of viewers watch them. The penetration, if I may use an advertising man's word, of terrestrial television—the number of people who can receive it—is 99 per cent. of the population, or 23 million households. The penetration of satellite and cable is 18 per cent., or 4 million households. When a major event is transferred from one format to the other, most of our constituents cannot see it. The viewing figures speak for themselves. Earlier this year, as any football supporter will know, one of the major events of the season—the game between Manchester United and Blackburn Rovers—easily achieved Sky's largest viewing figure of 1.2 million.
When ITV had the contract for First Division football four years ago, a game between Manchester United and Leeds United in 1991 attracted 9.3 million viewers. The simple averages are as follows: on average, under 1 million watch games on Sky, but when games were available on the terrestrial channels, the averages were between 7.5 million and 8 million viewers.
The net effect has been the loss of millions of potential viewers of major sporting events. We must be clear that recorded highlights are no substitute. Any sports enthusiast would agree with that. Indeed, shrewd television company managers are not interested in the sporting highlights. They are aware that if they want to get the viewers, they must show sport live.
Some people will say, "Don't worry; it will not be long before everyone has satellite and cable." Even the most optimistic estimates are that there is no possibility of that happening in the foreseeable future. There is no chance of anything like half the population of this country having access to such stations before the turn of the century. In the lifetime of any hon. Member in the Chamber, there is no chance of satellite and cable having the same level of access as the terrestrial television companies.
We must also consider the cost. If someone wants to watch major sporting events on satellite or cable, that will cost about £180 a year. From the viewers' point of view, what was previously part of their normal television service is now something that they have to pay large sums of money to have the privilege to watch. As Michael Grade, the head of Channel 4, said:
Sky's main contribution to choice has been the opportunity for the public to pay more for what they have already.


No one believes that there is any chance of those sporting events coming back to terrestrial stations once they are lost. All the executives of the television companies that I know anything about admit that they cannot compete, with their overall obligations for programming in financial terms, with a dedicated sports channel with a high subscription.
There is also a loss to sport. If young people, in particular, cannot see major sporting events, it is bad news for the future of the sport. It may be all right for the heads of the major sporting authorities such as the Football League or the Football Association to say that they will make money in the short term by selling exclusive rights to certain sporting events. However, that is a very short-term view. Although money may be available in the short term, people will not have the opportunity to see those sports in the long run and, one hopes, be encouraged to play them. We are all aware of the impact of television on the interests of people and their likelihood of playing sports.
In the short time left to me, I want to explain that my Bill is an attempt to stop the rot in respect of the loss of major sporting events from the major channels. The recommendation in my Bill is in line with the recommendation of the National Heritage Select Committee, which stated in its report last year that the major listed events—the English and Scottish cup finals, the World cup finals, the Wimbledon finals, test cricket in England, the grand national and the Derby—should not be available exclusively on subscription channels. That would effectively protect them for the main terrestrial channels.
For that to happen, there would have to be a change in the Broadcasting Act 1990, but I believe that that change would have overwhelming popular support. I would go much further: I would like to see many more major sporting events included in the list so that they are protected for the enjoyment of all of us and not just retained for a few.
The members of the National Heritage Select Committee and many other hon. Members can be under no illusion that there is overwhelming public support for my proposal. In far too many areas of our national life, good things that we have grown up with have been steadily eroded and we are poorer as a result. The

spectacle and drama of sport at the highest level brings pleasure to millions for all of us to see. In the past, due to our democratically regulated broadcasting system, we were able to see those events. I commend my Bill to the House.

Mr. Nick Hawkins: I oppose the motion in a qualified way. I have written to the hon. Member for The Wrekin (Mr. Grocott) to say that I support the broad thrust of what he seeks to do; but, as the chairman of the Conservative Back-Bench sports committee, I simply ask him to bear in mind something that he mentioned towards the end of his remarks. There is a substantial responsibility on the part of the national sporting bodies not to go for short-term profit, but to ensure that national sporting occasions are, as he suggested, available to all.
I hold no brief for the cable television channels, and I support the broad thrust of what the hon. Gentleman is seeking to do. [Interruption.] I hope that he will concentrate on encouraging—

Madam Speaker: Order. The hon. Gentleman should be aware that he must raise his voice in opposition.

Question put, pursuant to Standing Order No. 19 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business), and agreed to.

Bill ordered to be brought in by Mr. Bruce Grocott, Ms Hilary Armstrong, Mr. Ronnie Campbell, Mr. Robin Corbett, Mr. Bryan Davies, Mr. Don Dixon, Mr. John Evans, Mr. John Maxton, Ms Estelle Morris, Mr. Chris Mullin, Mr. Ken Purchase and Mr. Dennis Turner.

TELEVISION SPORT (PUBLIC ACCESS)

Mr. Bruce Grocott accordingly presented a Bill to amend the Broadcasting Act 1990 to provide that listed national sporting events, namely the F.I.F.A. World Cup Finals, the F.A. Cup Final, the Scottish F.A. Cup Final, the Wimbledon Finals, the Olympic Games, the Derby, the Grand National and Test Matches in England continue to be available on terrestrial television, and for connected purposes: And the same was read the First time; and ordered to be read a Second time upon Friday 21 April, and to be printed. [Bill 53.]

Orders of the Day — Health Authorities Bill

As amended (in the Standing Committee), considered.

New clause 1

ANNUAL REPORT TO PARLIAMENT ON ACTIVITIES OF REGIONAL OFFICES OF THE NATIONAL HEALTH SERVICE

'After section 8 of the National Health Service Act 1977 there shall be inserted—

Annual report on activities of regional offices of NHS executive

9.—(1) It shall be the duty of the Secretary of State to lay before both Houses of Parliament an annual report on the activities of the regional offices of the National Health Service Management Executive in respect of the discharge of all duties and functions transferred to those offices from Regional Health Authorities with effect from 1st April 1996.

(2) In this section, 'regional office' means any office of the National Health Service for the time being designated by the Secretary of State to have responsibility for the "oversight of the finances and activities of National Health Service purchasing authorities and trusts on a regional basis.'.—[Mrs. Beckett.]

Brought up, and read the First time.

Mrs. Margaret Beckett: I beg to move, That the clause be read a Second time.

Madam Speaker: With this, it will be convenient to discuss new clause 2—Duty of Secretary of State to publish accounts relating to projected expenditure savings—
'The Secretary of State shall, no later than 1st April 1997, lay before the House of Commons a statement of accounts giving—
(a) the level of expenditure on National Health Service administration in the financial year ending on 31st March 1996, excluding any expenditure attributable to the costs of implementing this Act,
(b) the estimated outturn of expenditure on National Health Service administration for the financial year ending on 31st March 1997, and
(c) an explanation of the factors to which any differences between the figures provided under paragraphs (a) and (b) above are attributed.'.

Mrs. Beckett: New clauses 1 and 2 go to the heart of the Government's purpose, or what we believe to be their purpose, in enacting the Bill, although new clause 2 relates principally to the financial consequences of the Bill. New clause 1 creates a mechanism by which Parliament can be informed of the outcome of the legislation, and can monitor its effects in practice as opposed to in claimed intent.
If the Government's real intention is what they claim—to remove unnecessary bureaucracy, to increase efficiency and create savings—the new clause will present them with no problems whatever. It creates an opportunity for the Government to parade their achievements. If, on the other hand, the Government's real intention is not what they claim but what we fear—to prevent public and parliamentary scrutiny of an operation which is to be carried out for the purposes of sheer dogma without regard for its potential and considerable practical difficulties and which might seriously inhibit the future

smooth running of the national health service—new clause 1, calling as it does for an annual report to Parliament, will be the last thing they want.
Although the logic of new clause 1 is impeccable and its case irresistible, if the Government's primary purpose in moving the Bill was to draw a cloak of secrecy across the operation of the NHS, new clause 1—with its adherence to the principle of accountability to Parliament and to the public—strikes at that purpose itself. The logic of and the case for the new clause are irresistible, because the Bill is not just half-baked, it is not baked at all.
In 1991, as part of the Government's so-called reforms, regional health authorities were given greater powers because it was judged that a strategic authority at regional level was required. On Second Reading, we highlighted some of the major responsibilities of the existing regional authorities, and our wish to explore in Committee how they would be addressed in future. We have had the Committee, but—in all too many cases—we have not had the answers. It is bad enough that, as usual, the Government have left so much to later regulation. But not only is there no detail as to what those regulations might contain, it seems all too often that the decisions have not even been made. Issue after issue is "to be decided" or is "being discussed", including the key issues of how future doctors and nurses will he trained and by whom they will be employed.
A Government who embark on such a major structural change without working out how its consequences will be dealt with are a Government of crass irresponsibility. Incidentally, it casts an interesting light on the demands of Conservative Members for details of policies which the Labour party might pursue after the next election that this Bill is on its way to the statute book without the details having been worked out.
Two matters are crystal clear: first, the Bill will allow infinitely greater secrecy and concealment in hospitals and trusts; and, secondly, it will ensure that all roads lead back to the Secretary of State. At present, regional directors of public health have a duty to produce an annual public report on health care in their region. Historically, the role of practitioners of public health medicine as potential whistle blowers for public safety is one of the glories of British medicine and British public service. At regional level, they will become civil servants, bound by the Official Secrets Act 1911, their duty not to the public but to the Secretary of State.
The only remotely independent voice in the new structure that the Bill creates is that of the community health councils. Their chief executives—full-time salaried public servants—are presently employed by regional health authorities. We asked what will become of them and whether they, too, would become not public servants in the employment of regional offices but civil servants whose duty is to the Secretary of State. No answer came.
At present, regional health authorities collect statistics at regional level and, as public servants, make much of that information public if requested. The only information that we can currently get about matters such as hospital closures comes from those regional health authorities. The Department of Health does not know about such matters and does not want to know. It tells us that, in future, regional offices will collect only the statistics that the Department wants for its own purposes in administering the system. On precedent, that would presumably not include information about hospital closures, the closure of


accident and emergency departments or other such decisions, which impinge directly on the pattern of available health care across a region and which are certainly of public interest, whether the Department wants to know them or not.
Apart from the information that the regional health authorities will no longer collect, any requests for information, for example from Members of Parliament, will in future be referred to individual authorities or trusts. So there will not be the same responsibility for the flow of information to the public or their representatives for the use of public money.
The mechanism in new clause 1 would allow Parliament to explore how those and other functions of existing regional health authorities are being carried out under the new structure or, if they are not being carried out, to consider the effects of the change. Vital responsibilities of the present regional health authorities are to stay at regional office level, including oversight of the cancer screening programme and maintenance of cancer registers—at least until what the Minister called "other arrangements" can be made, whatever that may mean. National confidential inquiries may still be handled at that level. Existing ethnic health units will be "centralised" in the NHS, whatever that may mean for their future and role.
When we inquired about the training and education of clinical staff, we were told that it was "to be decided", although later the Minister of State said that it might remain "at regional level", as will the training of some junior doctors. However, the arrangements for such training and how they can take account of the role of universities and the dual academic-clinical role of postgraduate deans is, again, far from clear—if it has been decided at all.
That group of issues is vital to the future of Britain's health care. The training of doctors, nurses and other health service staff, such as physiotherapists, and the holding of employment contracts for junior doctors impinge directly on whether the terms of their employment facilitate or even permit their continuing education.
On all those matters, practitioners and their representatives express deep concern. They are alarmed at the prospect that those matters might be decided, in practice if not in theory, at the level of the individual trust, whose purpose, laid on it by the Government, is to secure its own future as a profitable health business, competing with other such businesses—not to co-operate in a general endeavour of training and employment, from which it can derive, as an individual trust, only partial benefit.
We recognise that the Government have spoken of the possibility of consortiums, variously of trusts or authorities, but the fact that they continued to discuss in Committee an issue of such relevance and importance as the holding of junior doctors' contracts, highlights the recklessness of the endeavour behind the Bill and the irresponsibility with which those fundamental decisions have been approached.
There remain severe doubts, including among health professionals, whether the new authorities that the Bill creates in place of regions will have the expertise to plan and co-ordinate the existing activities of those regional health authorities.
All that shows that, whether at regional office level or away from that level, there is a continuing and important role to be played by those charged with carrying out duties that are currently the responsibility of regional health authorities. Parliament must have the chance to scrutinise the effects of the legislation, not only by discussing regulations when they are proposed, but by exploring, year by year, the cumulative practical changes to which the Bill will give effect.
It is useless to pretend that, under the new structure, even our present access to information will be maintained. Members of Parliament and other people with queries about the running of the health service will be referred to the individual authority or institution. Those are institutions in which staff at every level have gagging clauses in their contracts and local—no doubt soon performance-related—pay, to encourage them to remember where their loyalties are supposed to lie: not, as Mr. Roy Lilley recently remarked, to the patient, but to the organisation.
The position that appears likely to exist after the passage of the Bill reminds me strongly of the famous quote from Henry IV Part I, in which Glendower says that he can
call spirits from the vasty deep",
only for Hotspur to reply,
"Why, so can I, or so can any man,
But will they come when you do call for them?"
Will the information come from the authorities or trusts when Members of Parliament or other people call for it?
A classic example from proceedings in Committee illustrates why we doubt that the answer might come when we call for it; it is a classic example of the way in which that process works now, even before the Bill reaches the statute book.
My hon. Friend the Member for Stockport (Ms Coffey) told the Committee that she had been so impertinent as to ask the chief executive of her local trust exactly how the trust had spent £215,000 of taxpayer's money on the costs of setting up that trust. That was a small part of the £120 million or so devoted to that purpose throughout Britain, but a substantial sum of taxpayer's money none the less. When she spoke in Committee—and, as far as I am aware, to this day—the chief executive had declined to reply, thinking it, presumably, none of her business how he chooses to spend what the previous Prime Minister used to call "our money".
What advice did my hon. Friend the Member for Stockport receive from the Parliamentary Under-Secretary of State, the hon. Member for Bolton, West (Mr. Sackville), that staunch tribune of the people, the defender of the public purse? He advised her to
work to improve her relationship with the chief executive of her local trust"—[Official Report, Standing Committee A, 26 January 1995; c. 54.]—
in the hope, presumably, that if she did so he might condescend to answer her letter and her queries on behalf of her constituents.
No doubt Ministers will dispute whether the further concealment of the truth about the national health service is part of the purpose of the Bill. They cannot dispute, because they themselves acknowledge it, that the effect of the Bill will be the removal of information now in the public domain. New clause 1 would go some way to redressing the balance; I therefore commend it to the House.

The Minister for Health (Mr. Gerald Malone): I am pleased to be able to respond to what has been a short debate on an important matter. It is obvious that those of my colleagues who were sitting, hanging on my every word in Committee, have been entirely convinced by the debates that we had on that occasion.
The right hon. Member for Derby, South (Mrs. Beckett) talked about the "cloak of secrecy" which will be introduced with the passage of the Bill. I reiterate what I said in Committee: nothing could be further from the truth, and I welcome this opportunity to set out how the arrangements will work.
The regional offices will be an integral part of the NHS executive and, therefore, part of the reporting arrangements which are already in place for the Department of Health through the departmental annual report. That is not simply a report which is issued to the public; it is a Command Paper which is laid before Parliament and is available to the public. It describes in detail the Department's activities and expenditure across all its responsibilities. The right hon. Lady said that information would be concealed, but the opposite is the case. The Department remains accountable to the House through its annual report and I cannot think of any stronger accountability than that.
The right hon. Lady also said rather curiously, in an antithetical way, that all roads lead back to the Secretary of State under the new structure. They do, but the right hon. Lady cannot have it both ways. She argues one day that the national health service structure is not accountable either to the Secretary of State or to Parliament because the Government have fragmented it and sent it off in all sorts of directions, ending up in institutions which act on their own initiative and are accountable to no one. We sometimes hear that speech on a Monday afternoon, only to hear the right hon. Lady say on a Tuesday—as she has today—that all roads in the health service lead back to the Secretary of State.
Ultimately, all roads lead back not just to the Secretary of State but to the House, to whom Ministers are accountable. During that part of the Committee proceedings which I was fit and well enough to attend, I was at pains to emphasise the fact that that responsibility is extremely important and is taken very seriously.
Further information about NHS executive activities is made public through a wide range of publications, such as the NHS annual report. Further reports are planned, including a series of quarterly reviews which will start in May this year, an NHS quarterly magazine which will replace "NHS News" from June 1995 and, as the right hon. Lady knows, a range of statistical bulletins and issues-based newsletters concerning the performance of the service.
It is entirely wrong for the right hon. Lady to suggest that a "cloak of secrecy" surrounds the NHS. I think that there is more like a blizzard of information which is published directly either for the purposes of the House or for those who are keen to research those matters in their or the public interest, as well as for the general public. That approach is right and proper and it will continue under the new structure.

Mrs. Beckett: In making his remarks, I think that the Minister should address who controls the information that

is supplied. He says, quite correctly, that a blizzard of information is coming from the Department; but if one is so unwise as to request information which is not couched in precisely the form in which the Secretary of State chooses to release it, that information is not forthcoming.
I do not think that anyone—except perhaps a Minister in this Government—could defend the fact that the Department of Health does not, for example, collect statistics about the current number of hospitals, how many accident and emergency units are threatened with closure, or what the pattern of provision of such health care should be across the nation. That is exactly the kind of information that is collected by regional offices because, as regional health authorities, they have a separate duty to the public. All that information will now be controlled by the Secretary of State, and precedent suggests that she does not tell anyone anything that does not suit her purposes.

Mr. Malone: The right hon. Lady is entirely wrong about that issue. Information must be collected for statutory purposes—for example, to fulfil the requirements of the Public Accounts Committee and the Audit Commission and to report to the House through the departmental annual report. I regret that the right hon. Lady and her hon. Friends sometimes table questions in a way that does not allow me to answer them, simply because information is not available in the form requested. There are occasions when we puzzle over the questions, and only after conversations with the right hon. Lady's researchers are we able to guess at the purpose of a question.

Mr. Nicholas Brown: rose—

Mr. Malone: We do what we can to answer and to be as full and frank as possible on every occasion. In that spirit, I give way to the hon. Gentleman.

Mr. Brown: The whole House has obviously caught the Minister in a good mood and that is to be welcomed. If he is saying, as he has on countless occasions, that information is not held centrally and, therefore, the questions that we table seeking factual information are not properly worded, perhaps he will assist the whole House by telling us in plain English how we could table a question to find out how many hospitals there currently are, how many his Department has closed and how many his Department plans to close.

Mr. Malone: To answer the hon. Gentleman's last point first, we do not keep statistics on hypothetical questions. The other points that he raises relate to matters of definition—for example, what one defines as a hospital. There are many institutions that he may define as a hospital, that perhaps a member of the public might not define as a hospital, where information is held. The Government would never mislead the hon. Gentleman in any way by giving him any information that could not be precisely defined.
While I have the opportunity to engage the hon. Gentleman's attention on this point, I hope that he will recollect that when questions are tabled, perhaps some regard could be had for the public expense incurred in answering them. I say that not about questions that seek


genuine information but about those that repeat what has been asked, sometimes a week previously, by his hon. Friends, and answered.
I should also mention questions which are clearly trawling exercises for the purpose of basic research and on which published information is readily available. On one occasion, 155 questions were tabled in one day, at huge public expense and involving huge consumption of management time. I hope that we can use the debate to achieve a modus operandi so that public cash is not wasted on consuming health resources, which could otherwise be spent on patient care, by littering the Order Paper with what is essentially unnecessary.

Ms Ann Coffey: Is the Minister saying that, in future, he will not be able to answer questions about hospital closures because his Department no longer has a definition of a hospital? If so, that will be an interesting debate.

Mr. Malone: I shall be guided by better information than the hon. Lady suggests. Certainly that would not apply to matters which are ultimately the Department's responsibility and in which regional offices are involved, especially where such matters are referred directly to Ministers. Of course we shall continue to answer questions on those matters.

Mr. Kevin Hughes: rose—

Mr. Malone: Before I move on, I shall give way to the hon. Gentleman, as I am in an extremely good mood this afternoon.

Mr. Hughes: I am grateful to the Minister for giving way and even more grateful for his good mood. How does he define a hospital? It is interesting that the definition of a hospital is no longer what it used to be. I would be grateful if the Minister would say what he means by a hospital, so that not only Opposition Members but everybody else can be clear about just what it is.

Mr. Malone: The hon. Gentleman's uncertainty underlines my point that it may not be sensible to try to hit on a precise definition.
Opposition Members have often said—the right hon. Member for Derby, South repeated it this afternoon—that the move from regional health authorities to NHS executive regional offices, which will be part of the service, will mean a loss of openness. The right hon. Lady asked specifically what would happen to reports from directors of public health. As I believe I said in Committee, regional directors of public health will not publish reports, for the simple reason that the function that they currently exercise will be devolved nearer the population, to health authorities. They will continue to make reports, but in the context of the health authorities. I hope that I have finally got the point across to the right hon. Lady.
I hope to persuade the right hon. Lady that, as directors' reports will be made at health authority level, they will be far more relevant to smaller population groups. That is important when we are trying to identify and address health needs on an authority-by-authority basis. In any event, regional offices are not the bodies that need to be independent, as the right hon. Lady suggested. They will not make the decisions that will affect local people directly—the new health authorities will make those

decisions. They will be independent in the same way as regional health authorities and, in addition—under the codes of conduct and accountability issued in April 1994, which we discussed a good deal in Committee—will be expected to produce and publish annual reports.
The regional offices will have a monitoring role. They will contribute to the development of central policies for the NHS, influencing the policy-making process by offering advice to Ministers. It is entirely appropriate for such tasks—including any that involve the collation of reports from health authority public health directors—to be performed by civil servants, who will be part of the process that requires direct accountability to Ministers.
As for centralisation, as a result of the 1990 reforms responsibility has already been successfully devolved from regional health authorities to a level that is closer to patients. The Bill will devolve it still further by moving vital functions, such as non-medical work force planning and many public health functions, down from RHAs to the new health authorities.
The right hon. Member for Derby, South said that the reforms had not been thought through. In Committee, we did not discuss which functions would reside where after the enactment of the Bill. I shall not detain the House by repeating the lengthy statement of functions that I made in Committee, but I draw it to the right hon. Lady's attention. It seemed, if not to satisfy the Committee, certainly to silence it—which, at the time, I may have interpreted as something rather different.
The right hon. Lady referred specifically to training and employment contracts. The Committee dealt with that in some detail, but for the sake of certainty I shall reiterate the position. The education contracts of registrars and senior registrars will be held at regional level by postgraduate deans; in Committee it was widely conceded that that was by far the most important aspect of the contracts, and the main source of concern.
Future arrangements for the holding of contracts are still under discussion, but, as I said in Committee, that is more a technical matter. The fundamental issues were what would happen to education and who would guarantee that doctors could move around the system to secure proper training. I welcome this opportunity to tell the whole House that postgraduate deans will have that responsibility.
I simply do not accept the premise from which the right hon. Lady starts—that this addition to the Bill is necessary. It is not true that less information is available on the service than before. Under the new national health service, far more information is available than ever before. Trusts are accountable to their patients and must publish annual reports. Across the country, more information exists about the performance of the health service in terms of waiting lists and of the quality of institutions that deliver health care, and it is much more widely available than in the past. Much of the debate that we have in the House and elsewhere about how the health service is performing involves information that is used by Opposition right hon. and hon. Members. In years past, under the old NHS, the lack of information would not have allowed such a debate to take place.
The combination of annual reports, accounts and league tables—vital information that tells us how public money is accounted for, and how it is translated into patient care—is accessible not only to hon. Members but to a wider public. The new clause is not necessary. The service


will ultimately remain accountable in a proper way to the House. Perhaps, although I fear that this is a forlorn hope, the right hon. Lady will seek to withdraw the motion.

Ms Coffey: The new clause seeks to make information available. I note the Minister's comment that he thinks that information is already freely available. He mentioned that the information will be available in the annual accounts of trusts, but I understand that the trusts' annual reports will be late this year. I have no clear idea of when my local trust's annual report, which will make all this information available to me, will be published.
In Committee, I raised the issue of the £215,000 that has been spent by my health care trust on set-up costs. I have failed to obtain information from the trust's chief executive on how that money was spent. That is clearly symptomatic of the problem that Members of Parliament have in obtaining information from trusts. In a letter to me, the chairperson of the local acute services trust, said:
As far as accountability is concerned I am directly accountable to the Minister who is of course accountable to Parliament for the trust's action".
Why is it then that, when I write to the Minister about some aspect of my local trust, he refers me back to the trust? Somehow, this wonderful circle of accountability does not go the circle.
The £215,000 is public money, and was given to the trust for set-up costs. I have consistently asked the simple question: can the chief executive tell me how that £215,000 was spent? He has refused to tell me. He has referred me to the annual report. That seems illogical: if the information will be available in the annual report, why cannot the information be available to me now?

Mr. Malone: rose—

Ms Coffey: The Minister is going to tell me.

Mr. Malone: I ran through an analysis of start-up costs in Committee. I cannot give the hon. Lady a breakdown of the figures precisely in relation to her own hospital, but I will be delighted to consider that matter and to give her whatever information is available. I will write to her on that point.
I have no idea where she gets the suggestion that reports will be published late—that is news to me. When those reports are published, more information will be available, for example, on management costs. That is an important step forward, which she would doubtless welcome, because Opposition Members question the service about the proportion of funding that is being spent on those costs. I hope that that underpins the serious intention of the Government to disclose, wherever possible, as much information as possible, so that the true performance of trusts will be publicly visible beyond the service itself.

Ms Coffey: I was told that the annual accounts were to be late in a letter from one of the Ministers in reply to my letter asking why the information about the £215,000 was not being given to me. He referred me to the annual report, and said that it would be late. I should be happy to show the Minister the letter.
I welcome the fact that the Minister intends to give me a breakdown of the £215,000 set-up costs. I should be happy if the Minister would tell the chief executive of my

local health care trust that the information should be made available to Members of Parliament. That would be a great step forward. I am sure that the chief executive believes that, by not giving me the information, he is in some way carrying out the Government's wishes. Clearly that is not right, and he must be made aware of that, as must all chief executives of trusts.
4.30 pm
The main issue I wish to raise with the Minister deals with the monitoring of the programme to discharge mentally handicapped people into the local community once the regional health authorities have been abolished. As the Minister is aware, the programme has been going on for several years and involves closing down institutions such as Cranage or Offerton house in my constituency, which for years nursed mentally handicapped people in an institutional setting.
Over the years, that programme has been the subject of some financial dispute and argument between local authorities, district health authorities and regional health authorities. The arguments involved the money for those patients—it has been referred to in the past as dowries—as well as arrangements for financing the entire programme, including complicated deals about the notional value of regional health authority land and the selling off of that land.
The programme is almost complete: effectively, the regional health authority programme has transferred to the health authorities, and people with mental handicaps are living in houses in the community. Financially, they are living as normal people, entitled to housing benefit and other benefits. Care is being provided by the health authorities and, in my locality, staff employed by the health care trust go in on a daily basis to care for those people.
The patients are highly dependent; some of them have been living in institutions for many years. Therefore, transferring to the community can be difficult. The care they need must be of the highest quality, because, however much we talk about them living as normal people, their needs make them special. They are a risk to themselves: unfortunately, in Stockport recently a mentally handicapped person died in one of those homes.
The care provided is paid for by the local health care trust, which also employs the staff. As far as I can see, this has nothing to do with the Stockport health commission, and there is no commissioning role in buying the care. It is provided through the money from the regional health authority, and has ended up with the health care trust.
I can see several problems with this. If the Government felt able to accept the new clause, I believe that some of the inherent difficulties and conflicts might be resolved. A local health care trust should not be responsible for employing staff and providing care, because the cost of that care and the staff come out of the same budget.
I was quite concerned to see an advert in my local paper, which asked for staff and said that experience with mentally handicapped people was desirable but not necessary. A cynical thought passed through my head—of course, it costs less to employ unqualified people than qualified people. The ratio of unqualified to qualified people in Stockport is on a balance with the unqualified people who are employed part-time on a bank staff basis, where at the beginning of the week they are sent here,


there and everywhere, depending on where the need is. That, obviously, is cheaper than employing full-time or fully trained staff.
There is an inherent conflict, because if there is pressure on the budget—and there was last year—what better way of saving money is there than by employing less qualified staff on a lower rate of pay? That is not right, because mentally handicapped people who come into those homes have care plans, and the same authority that supplies and employs the staff monitors that care plan.
That cannot be right. There seems to be no independent inspection. There are no targets laid down by the Government about the quality of care. The homes are not subject to inspection, because they are not considered to be residential homes. The health and safety regulations do not apply. The homes are, in fact, operated as mini-institutions.
I am concerned about the quality of life for people in those mini-institutions. I have always supported the ideology behind community care—that institutions are not homes for people, and that it is better for people to be in a home and for care to be put into that home—but surely quality must be addressed. If mentally handicapped people in those homes are not provided with day care or stimulus outside the home, and if day care simply means providing them with Sky Television 24 hours a day. I am concerned about the quality of care, because that is not what community care is supposed to be about.
Who assesses whether the quality of care for those people is better than that in the hospital in which they were previously resident? Community care is supposed to be about improving the quality of people's lives. Where, and by whom, is that judgment made? I am concerned, because of the abolition of the regional health authorities, and the duties of the new regional offices not being clear by any means, about how the programme is being monitored across the country. Monitored it must be, and properly inspected. Mentally handicapped people need protection. They cannot speak for themselves. There must be some independent inspection of their needs and the quality of their lives.
I am not sure how the Minister will address that question and what input the regional offices will have. If there is a commissioning body—a health commission—and a provider unit, as in the trusts, in a sense there is some inspection by the health commission, because it purchases care and can demand to see the quality of that care.
But if the provision and purchasing of the care happens within the same organization—for example, the trust—which appears to be the case in the care of mentally handicapped people, I suggest to the Minister that will stack up problems for the future. There must be some way in which to provide some independent inspection, whether that means, when the regional health offices go, placing that role back into the health commission and giving it the responsibility of commissioning care for mentally handicapped people. Perhaps that is a way round it. I am sure that it is not the only issue that needs to be dealt with, but it is in my thoughts, as this is happening in my constituency. No doubt other hon. Members could think of a number of other issues to be raised in this context.
The problem is that it is not clear what the regional offices will be monitoring, and what their responsibilities will be. At one level, this important Bill may seem uncontroversial, but I suspect that it will have far-reaching consequences for the delivery of health care. It therefore

seems especially regrettable that it does not contain sufficient clarity. As we have discovered, we sometimes pass legislation without paying sufficient attention to its consequences.
The new clause offers a safety net by ensuring that proper monitoring takes place and that appropriate information is available to the public. The Government claim to be in favour of access to information, so I do not understand why they do not support the new clause and ensure that information is open to the public.

Mr. Martin Redmond: I apologise to the Minister of State for having missed the beginning of his speech, but I was upstairs at a meeting of the Carers National Association, listening to the trials and tribulations experienced by its members because of Government policies.
My remarks all relate to accountability, or the lack of it. There is going to be no accountability in the national health service. The regional health authorities are to be kicked into obscurity, and their replacements will mean an absence of accountability. Brian Edwards, who used to be the secretary of Trent Regional health authority, has moved up into the money markets, and we have heard a great deal recently about people who have done extremely well.
Let us consider the appointment of the chairman of the trust in Doncaster and of the people who sit on the board. It is remarkable that those people do not represent a cross-section of the community; it seems that only people from a certain clique are wanted. The Minister and the Secretary of State must take responsibility for such appointments. For there to be accountability, the people who sit on trusts should be under no obligation to the Conservative party. Due consideration should be given to the secretaries and chairmen of the community health care councils sitting, as of right, on trust boards.
In the old days of the area health authorities, the press were invited to attend meetings, and the only matters from which they were excluded were those that required patient confidentiality. That is the only way to be open and above board, and avoid the sort of scandals about which we have recently heard so much. I am all for reform and progress, but making progress means going forward, not back to Victorian days.
I have been to hospital in the past couple of years, and have been fortunate enough to receive excellent treatment from nurses and doctors. Indeed, were it not for their skills, I should not be here now. I have much to be grateful for, and I am sad to see the health service, which I love, being dismantled because of the Conservative party's political dogma.
The Doncaster health authority used to spend about 3.5 per cent. of its budget on administration costs. I suspect that, were the Minister to do a similar calculation of the trusts' administration costs, he would find that the figure was more like 8 per cent. I am guessing, but it is an educated guess. In any event, it means that a tremendous percentage of available funds is not being spent on patient care.
4.45 pm
I believe that there is more accountability and openness among the Freemasons than in the health service. [HON. MEMBERS: "How do you know?"] I live in the real


world of the doctors and nurses. I hear the Minister, the Secretary of State and Conservative Members expound the benefits of the new arrangements and talk about money in "real terms", but I lie in bed at night adding up the hours that junior doctors spend on the wards, and they are unacceptable.
The general waste and handouts to get rid of bad appointees as chairmen of authorities all adds to the lack of accountability. Conservative Members should go out into the real world and talk to nurses and doctors, not the lackeys appointed by the Secretary of State. Patients praise the dedication of the nurses but condemn the money wasted on administration. Accountability is important, and the Conservatives need to understand what is really going on.

Mrs. Bridget Prentice: Once again, I stress the need for a strategic health authority for London but the Bill as drafted does not allow for the accountability that Londoners need in terms of their health care.
My remarks are intended as an act of kindness. In London, as elsewhere, the Government are singularly unpopular and have wholly misunderstood what people in London want. We are giving them the opportunity to rectify that. I hope that the Minister will accept the new clause as a measure of good will and take it as an opportunity for the Government to join us in seeking to provide a strategic health authority for London. It would be a popular decision among Londoners and would go some way to meeting London's health care needs. The chances are that my words will fall on deaf ears yet again, but I live in hope that one day even the Government might listen to Londoners.
Yesterday, I listened carefully to the Secretary of State's speech on the health crisis in London. She talked at length about what was happening in London as a whole. I should have thought that even her comments made it clear that there is a need for strategic thinking when planning health care and health provision across London. It is not just that the capital city needs strategic planning—it does fundamentally. Strategic planning is important because the needs within London as a whole and within inner London in particular are so much greater than they are elsewhere.
The Government often like to divide London from the rest of the country on the ground that London is over-resourced compared with the rest of the country. A number of the reports that have come out in the past year or two—certainly since the Secretary of State began her reforms in London—show that the Tomlinson report, on which the Secretary of State has based her slashing of services in London, was flawed because it was based on a great deal of misinformation, inaccurate statistics and unfounded dogma.
Not only Professor Jarman but others have shown that the acute bed need in London is great, that waiting lists are now rising rapidly and that the health needs in London are significant compared with those elsewhere. London obviously has the highest level of homelessness in the country. I use the word "obviously" because people are attracted to the capital city, which is one reason why homelessness is so bad in the capital. There is also more pressure on housing to rent in London than there is elsewhere. Young people in particular have no

opportunity to get decent housing. Every medical expert tells us that homelessness has an effect on people's health. The level of homelessness is one way in which London is unique compared with the rest of the country.
As a number of my hon. Friends have mentioned in other debates, London has the highest level of people who are HIV positive or who have Aids-related diseases which require specialist care in hospitals, in people's homes and in community care facilities. Such specialisation is costly, but it is necessary and we must do all that we can to ensure that whatever the resources available for people who are HIV positive or who have AIDS, they are made available to people when they need them.
The capital also has the highest level of drug dependency in the country. This is a specialist area and we need to consider how to get resources to people as quickly as possible so that we can help them to survive. The amount of poor housing in London, the extent of homelessness and a series of other factors mean that other debilitating diseases are more prevalent in the capital city than elsewhere.
The comments of the Secretary of State suggest that a strategic health authority for our capital city is vital. It is extremely sad that the Government have ruled against any possibility of such an authority being set up. Instead of setting up that strategic authority, as they could have done under the Bill, they have removed the present level of accountability, small though it is, to the regional offices. That will not reflect the needs of people in London.
The Bill will have an especially dire effect on two areas. The Secretary of State has talked a great deal about care for the elderly and she appears to be terribly proud of her community care policy. In my experience and in the experience of many colleagues on both sides of the House, care in the community is simply not working in London.
When elderly people are discharged from hospital and sent back to their homes, often with only an elderly, frail relative to care for them, there is little back-up and little thought is given to the resources and resource management that are needed to ensure that people can recover properly from whatever illness put them in hospital in the first place. Some people have to go back to hospital for a second or third time and others, sadly, do not survive the experience at all. Unless we have a strategic overview of what happens in our hospitals in London and of what happens when people are discharged from hospital into their local community, we shall not serve the people of London well.
I now turn to mental health. My hon. Friend the Member for Stockport (Ms Coffey) mentioned mental health and spoke about the needs in her area. London has a greater need for mental health services than elsewhere. There are examples, right across the capital city, of people being discharged from institutions into the community without any resources to back them up. There have been a number of tragic instances.
A few weeks ago, a woman, who was not a constituent, came to my surgery. A relatively young person with a mental illness, who had been discharged into the community, attacked her when she had three children under five with her. Although she was not badly injured, it was a frightening experience and one that neither she nor anyone else would want to have. She recognises, as


the rest of us do, that the reason why such incidents happen is that there is no proper resourcing of community care in the city.
People should be discharged from institutions only if the Government are prepared to put resources into the local community to enable care to be given properly. Some time ago, there was the tragic affair of the Clunis report, with which the Guy's and Lewisham health trust had to deal. There have been many other cases which hon. Members can cite.
There is growing concern in the capital city that although people who have mental illnesses and those who are drug dependent or have some other specialist problems are more prevalent in London than elsewhere, they are not being properly looked after. The hospitals are totally under-resourced and we need to find a strategic way in which they can be resourced. Just before Christmas, there were examples of people with mental illness being shipped 50, 60 or 70 miles away because there were no beds in London in which they could be cared for.
The Government seem to be committed to ignoring what Londoners want. The new clause would enable the health service in London to become more accountable. That would go some way towards alleviating many of the fears of people in London about the state of the health service here.
I now touch on another aspect of accountability which I raised in Committee and which still concerns me because I do not believe that the Government have recognised the seriousness of the situation. I refer to the universities having a place on the health authorities. At present, they have a place on the existing health authorities as of right under a statutory provision. Under the Bill, that statutory place will be removed.
That will be a tragedy not just for the universities, which are well aware of the problems that will arise, but for the new health authorities. They will not have the direct expertise of the medical practitioners and the academics in the universities who know about their teaching methods and about their teaching programmes, and who can influence and support the health authorities to ensure that they dovetail their programmes of work with that of the universities.
Listening to the Secretary of State yesterday, I found it rather strange that she spoke eloquently about the centres of excellence and about the importance of our educational and academic training for doctors, in London in particular. The Secretary of State said:
I am also strongly committed to our international position and centres of excellence.
She said later in the debate, when talking about the importance of education and research:
Those are fundamental to the reputation of London as a world leader in medical teaching and research."—[Official Report. 20 February 1995; Vol. 255, c. 37–41.]
In that case, it strikes me that we ought to acknowledge teaching and research by ensuring that those academics are involved in the process of decision making in the hospital service.

Mr. Malone: I would not like the hon. Lady to give the House the impression that this matter has been disregarded and was not discussed in Committee. Of course it was and I pointed out in Committee that, if a medical school is in the area of the health authority, there

would be a medical school representative, a university representative, on the board. I made that absolutely clear. However, like every other board position of that sort, it will be prescribed in regulation. Perhaps the hon. Lady's debate is over whether those positions should be in regulation or in the Bill. She is giving the impression that there may not be representation at all. It is certainly the Government's intention—I gave an undertaking to that effect in Committee—that there will be such representation.

Mrs. Prentice: I am grateful to the Minister for making that clear. I was not clear about that in Committee. Although, as the Minister would expect, I disagree with him over the provision being prescribed in regulation; it should be in the Bill, but one step at a time is perhaps as much as we can hope to take with this Government.
I believe such representation to be important. I have a special interest in training in general and, in this context, in medical training in particular. The fact that it will be purely under regulation and not a statutory requirement evokes fear for two practical reasons. First, when hospitals are being rationalized—closed, to those of us who understand the term—it is very important that universities are centrally involved in decision making because the costs involved of moving staff and medical students from one hospital to another can be enormous, as some hospitals elsewhere in the country have found.
Secondly, universities fear, and justifiably so, that the Department for Education, which presently funds the moving of the medical training and therefore funds part of the health service, will say that it will not fund such future moves. Yet we must feel confident that universities are aware right from the start were such funding to cease, so that they can participate in the process and be party to events.
As I said, the costs of changes can be enormous. It cost £15 million in Oxford, £20 million in Glasgow and Edinburgh—

Mr. Deputy Speaker (Mr. Michael Morris): Order, I was hoping that the hon. Lady was coming to the end of that part of her speech. Frankly, the new clause does not apply to matters concerning the Department for Education.

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Mrs. Prentice: I am trying to establish the fact that the Department for Education funds part of the health service through the university medical schools, which is why accountability is so important. University medical schools need to be able to speak directly to the Department of Health about what is happening—

Mr. Deputy Speaker: Order. I was listening to the hon. Lady and I was well aware of the point that she was making. It is perfectly proper to make an aside, but she is developing the argument. I hope that she will now desist from that and return to the main thrust of her speech.

Mrs. Prentice: I am grateful, Mr. Deputy Speaker, and I shall move on, because the Minister has responded, to some extent, to my point.
I hope that, in responding to the debate, the Minister will remember that that aspect of accountability is centrally important if we are to ensure that those centres of excellence, which the Secretary of State discussed


yesterday, remain. I hope that there is accountability in medical education, and especially as an hon. Member who represents a London constituency which suffers great deprivation and has large demands, I hope that we consider again the need for a strategic authority in London to provide the accountability in their health service that Londoners want.

Mr. John Gunnell: The two new clauses are excellent, and I urge the Minister to look at them carefully and to consider accepting them. They would strengthen the health service and provide the Department of Health with a much better defence against the proposed reforms than they have been able to put up against the reforms which have already been implemented.
The new clauses are strongly linked and deal specifically with accountability, as most hon. Members who have spoken said. Accountability is very important. We recognise that there is an automatic lessening of accountability in moving from an authority that has some external features to a regional office of government. We recognise that that implies a loss of accountability, and we must establish how that accountability will be made good in the arrangements under the new plan.
Financial accountability is also very important. Projected expenditure savings have been made. However, my interpretation of the answer given by the Under-Secretary of State, the hon. Member for Bolton, West (Mr. Sackville), on the day of the Committee's last sitting, was incorrect. When I looked back at what he said, I realised that he had been consistent in suggesting that he had projected savings of £150 million which applied to the whole country. However, it is fair to say that the Under-Secretary of State for Wales, the hon. Member for Clwyd, North-West (Mr. Richards), purloined £60 million of that overall amount for Wales, which left £90 million for England.

The Parliamentary Under-Secretary of State for Wales (Mr. Rod Richards): indicated dissent.

Mr. Gunnell: It was said in Committee, and I urge the Under-Secretary to look at the relevant proceedings of the Committee sitting. We are talking about global figures, to which I shall return.
Nevertheless, it is important to note that if savings are projected and Ministers have any confidence in them at all, they will obviously welcome not only the duty to publish accounts but the opportunity to publish them, to demonstrate how right they were in their projections. If they do not publish accounts and are not able to accept new clause 2, it suggests that they are not so confident about their projected figures. I shall return to that point.
The annual report is an extremely valuable feature of the Bill. In response to questions which several hon. Members and I asked in Committee, the Minister said that he intended to make clear at some point where every responsibility of the present regional health authorities would lie in future. He indicated that they could all be dealt with and that all current responsibilities of regional health authorities would go somewhere to a specific responsibility—to a health authority or the regional offices which are being set up or to an even higher responsibility. It is important that that indication is

followed up—not merely by a statement from Ministers but by putting it into effect, so that the annual report clearly demonstrates how each function, if it has been necessary, is carried out.
As my hon. Friend the Member for Lewisham, East (Mrs. Prentice) said, we are dealing with the removal of a strategic tier. Many of us believe that strategic matters are best handled by an authority that takes an overall perspective of the issues as they affect the region. A regional perspective is therefore important in several respects.
Hon. Members have already referred to mental health. We must ensure that strategic facilities are available. The region plays an important role in that regard at the moment. I was a member of the health authority that contemplated the eventual closure of High Royds, a mental institution on the outskirts of Leeds. That institution is interesting as it sits on a large plot of land which, if suitable planning permission were given, would be extremely valuable. The institution was important to the region from a resource point of view. It was the region's job to allocate resources on a strategic basis throughout Yorkshire; therefore, the enormous accumulation of resources at Menston was an important potential asset, the use of which would have been determined strategically on a regional basis.
I come from the Yorkshire region. Even though the Under-Secretary of State for Health, the hon. Member for Bolton, West—who is not in the Chamber at the moment—has described me as a foreigner—

Mr. Dennis Turner: Disgraceful.

Mr. Gunnell: Yes, but one understands that, in Yorkshire, the definition of a foreigner is very precise. Under the Yorkshire county cricket club's former rules, I would certainly he regarded as a foreigner. Indeed, my hon. Friend the Member for Wolverhampton, South-East (Mr. Turner) would also he regarded as a foreigner.

Mr. Rhodri Morgan: What about as a KGB agent?

Mr. Gunnell: No, such accusations have not been levelled at me. I would have to wait a long time and have a more august position than I have at present in order for it to be worth while to make such suggestions.
From Yorkshire's point of view, the division of the large sum of money to which I have referred, and how it is allocated, is very important. Would it be allocated to mental illness, because mental illness requires huge resources? If we abolished the region and there were a great deal of income from a land sale, could we be sure that that money would be used in the area from which it came or, in the absence of regional authorities, would it go into a national pot?
From the allocation of resources we know how much can be done within the health service. The allocation of resources is currently a regional function. How will resources be allocated in the health service in future? Will they be allocated through the national health service executive? Will regional policy board members argue for resources for their regions in an executive that considers all the resources and distributes them on a national basis? If savings are made in a particular region, will those resources be allocated within that region'?
Ministers must have already decided what will happen. They must know how they intend to distribute resources. In the absence of regional health authorities, how will resources be distributed? That point could be covered in an annual report which states how that function of the region is determined. Only if we know how the resources will be allocated can we be sure that they will be distributed with roughly the same results as now.
I know that you take an interest in such matters, Mr. Deputy Speaker, because I recall the reception that you gave downstairs. You are obviously concerned about the care of those who suffer mental handicap or mental illness. Yesterday, I launched a report by the Matthew Trust which showed how the trust funded, with very small amounts of money, care for people who were mentally ill and had suffered some other hardship.
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The trust was concerned with very small amounts of money, but it was clear that a section of people had somehow fallen through the net of our social welfare system. One might say that it is the health authority's job to ensure that those individuals do not fall through the net. However, one might also say that there is a responsibility at every level to ensure that the safety net that we believe exists—hon. Members on both sides of the House believe that it exists in the welfare state—is made seamless so that fewer casualties fall through it.
Many of the people whom I learned of yesterday suffered from mental illness. Many of them had other handicaps—for example, they had been victims of crime. Those people were falling through the net and they clearly needed help. We must ensure that our strategy is right. If the strategy used to be determined in part at regional level, how will it operate in future?
Regions currently carry out many functions in respect of which we would like a report. When there are local disputes, the arbitration procedures are provided by the region. As we said in Committee, with regard to "The Health of the Nation", regions were given a specific function. Who will carry out that specific task of setting a health promotion strategy in future? Will there be a regional health promotion strategy or will it simply be a strategy set out by the Secretary of State here in the House?
There are clearly regional factors at play if we consider disease across the nation. I believe that there should be regional health promotion. What will happen in that respect? Although I did not attend yesterday's debate on health care in London, I am pleased to hear that the Secretary of State was concerned about centres of excellence. I wrote about the destruction of such centres of excellence and received a letter from the Minister for Health this week. I believe that we can learn lessons from the United States about the preservation of centres of excellence.
The regions have responsibility for research and development. Where has that responsibility gone or where is it going? What about a region's responsibility for registration? Responsibility for fundholders and their registration is going to the district health authorities. We have already discussed that, so it is not quite at issue now; if, however, there were an annual report, it could have been made plain that that responsibility had been transferred.
The responsibility for the appointment of community health council chairs currently rests with the region. Who will have that responsibility in future? The appointment of the chairs of community health councils and of those connected with the councils is very important, especially to local communities. When we come to talk about other health service appointments, we will have the benefit of a paper produced by the Secretary of State only this month which says that responsibility lies specifically with individual regional policy board members. We do not know whether responsibility for appointments to community health councils will also lie with regional policy board members.
A number of questions need to be answered. I would expect that an annual report would be able to say not just what was suggested by the Minister in Committee but where responsibility was exercised and who was exercising it. We need to know what will happen to those people who are working in the regional authority for the north and Yorkshire. We are told that there will be 135 people working initially in Harrogate, with some working in Durham and others elsewhere.
No doubt, some people will be transferred to the civil service. We need to know where those people are and what tasks they will carry out. We also need to know what tasks will be given to those people who have been transferred elsewhere. What will be done at Durham when the building is built? What will be done at Quarry house? Which matters will be dealt with in Whitehall for which the region is currently responsible?
In addition, we need to know about savings. My experience of savings brought about by abolition goes back to my time as leader of West Yorkshire metropolitan county council, when it was abolished. I was told that the abolition of my county, and five other metropolitan counties, would save £50 million. That does not sound much when it is compared with the £150 million that the Government claim will be saved by this change. It was claimed that the saving was one of the motivating factors for removing democracy and abolishing those authorities.
A study carried out three years after the abolition of those councils stated that, although it was not possible to say that the abolition had cost a great deal of money, it was certainly not possible to say that it had saved money. The report, produced by the university of Birmingham, suggested that the change had been financially neutral. I want there to be agreement that the forecasts that the Ministers make will be quantified. We must know where they think the savings will come from, as it is not enough to project a global figure of £150 million.
I can understand that there will be fewer appointments to health boards following the merging of authorities, and therefore I can see where some specific savings will be quantified. I do not believe that those savings will come anything near £150 million, and Ministers must state from where the other savings will come. New clause 2 says that a statement of accounts must be produced before 1 April 1997. that might be a significant month for the Government. They will not be able to last here any longer than that without public approval, but I believe that the public will approve the presence of the Conservative party on the Opposition Benches.
We know that health service reforms are a costly business. It is now a year and a half since the controller of the Audit Commission said that whether the NHS got value for money from its was a "very legitimate question".


I asked whether the Audit Commission had been allowed to look at the savings projected in the Bill, because that might have thrown an interesting light on the issue. That question was not answered, so I suspect that the Audit Commission has not been brought into the matter.
It would be helpful to look at some aspects of management in the NHS. We know that the management of the introduction of the reforms has already cost the best part of £1 billion. Have we had value for money for that amount? I doubt whether many patients would think that we have; I am quite sure that they would have preferred much less to be spent on management changes and much more spent on patient care.
We are talking about the future, and the Bill will bring about changes in the future. We are told the Bill will save £150 million. Hon. Members should ask for that to be demonstrated after the event so that, even if the changes are not justified in any other way, the Government can show that they have produced the forecast savings.
The examples which I have been able to raise do not fill me with confidence. I understand the Minister's reluctance to put the new team working for Yorkshire and Humberside in Quarry house. We are told that Quarry house, which is near the centre of Leeds, is not in the middle of the region. I accept that. Harrogate may be a bit better, but that is not the centre of gravity of the region either. That, no doubt, is the argument for going to Durham; but the costs of going there must be regarded in the light of the fact that there is space in the £55 million Quarry house building in Leeds and there is also a building in Harrogate which, for the particular reasons we gave in Committee, will not get the best price in the market at the moment.

Mr. Nicholas Brown: The situation is even worse than my hon. Friend outlines. There is, of course, a fourth building—the northern regional headquarters at Walkergate in Newcastle. Instead of having one headquarters per region, the Government—in their great push for efficiency and savings—are giving us four.

Mr. Gunnell: I thank my hon. Friend for that comment. It was remiss of me to have had such a Yorkshire-biased point of view. I ignored the building in Newcastle. [Interruption.] The Speaker admonished Members for going from one constituency to another. I was wondering whether the sacred turf of the Hawthorns in West Bromwich was in her patch, because hon. Members go there from time to time.
The questions about the costs of change and why there must be an increase in expenditure for a new building in Durham have been unanswered. Thanks to my hon. Friend the Member for Newcastle upon Tyne, East (Mr. Brown), I can say that there are three buildings which are being neglected while a new one is built. That is the antithesis of the suggestions which Ministers usually come up with. There is a strong case to ask Ministers to accept new clause 2, and to be prepared to publish the financial results of their activity.

Mr. Kevin Hughes: I have the feeling that I have been here before. The two new clauses are about accountability, and we explored the Bill's lack of accountability in Committee. We talked about democracy, openness,

accountability and consultation but we have not yet had a proper answer from the Minister of State on any of those issues. That does not surprise me, given his response when asked to define a hospital. If he cannot define what he means by a hospital, how on earth can we expect him to give us straight answers about democracy, openness, accountability and consultation? Is it really too much to ask a Minister what the Bill means and what the Government mean by accountability, openness and democracy?
The two new clauses are basically no different from what we have discussed in the past. My hon. Friend the Member for Don Valley (Mr. Redmond) referred to the secret service that operates in Doncaster. He and I share the same regional health authority and trusts, so we can both speak with experience about the lack of openness in our area. Other colleagues have a similar experience in their areas. We have the Doncaster Health Care trust; the district health authority, which is being merged with the family health service authority, piloting what the Bill is about; and the Doncaster Royal and Montagu Hospital trust. Of the three, the Doncaster Royal and Montagu Hospital trust—[Interruption.]
The Minister might like to listen to what I am about to say because Opposition Members do not often sing the praises of a trust. Of the three, the Doncaster Royal and Montagu trust is the most open and accountable, and invites local Members of Parliament to talk about what it is doing and proposes to do. That is significantly different from the other trust and certainly different from the district health authority.
New clause 1 seeks to have a report laid before the House. It says:
It shall be the duty of the Secretary of State to lay before both Houses of Parliament an annual report on the activities of the regional offices of the National Health Service Management Executive".
Those reports must be a valuable feature. What possible harm could they do? Do not we need to know what is happening in our health service? Do not we need to know about the overview of the new regional bodies? Let us not forget that people employed in those bodies will be civil servants. Will the Minister come to the Dispatch Box and justify why we should not have such a report? I see no reason whatever.
The Minister said earlier that hon. Members table too many parliamentary questions and waste public funds. If we had those reports and could find out what was happening, hon. Members might not need to table so many parliamentary questions. Who knows, the reports may even contain a definition of a hospital. If the Ministers do not know, somebody in the national health service executive may know what constitutes a hospital. I might table a parliamentary question later today asking the Minister to define a hospital, because he did not answer that question in the Chamber this afternoon. I find it incredible.
Let us not forget that the new bodies, which will be made up of civil servants, will still have a strategic role to play in overviewing their regions. It is important that we have that overview and a report on what is happening. Without a report, how will we know what those people are doing? Although they will report back to the Secretary of State, if a report is not laid before Parliament, we shall not know what is happening in our regions.
Apart from the Secretary of State, who will monitor the new regional bodies? Will they monitor themselves? A lot of self-monitoring seems to go on in the health service. After all, to be appointed to one of those bodies, it takes


just a nudge and a wink. My hon. Friend the Member for Don Valley mentioned the Freemasons and he may not have been too far from the truth, because the new trust boards and the district health authorities are like secret societies. No one seems to know how people are appointed to them. A nudge and a wink, a word here or there, and suddenly someone with no experience whatever in the health service is appointed. So long as they are a friend of a friend—they might happen to be a friend of the Tory party or a friend or relative of a Tory Member—they are appointed. We have been round that circle before.
New clause 2 is about accountability for expenditure in the health service. Again, I see no good reason why we should not have such accountability and why we cannot be told how taxpayers' money is being spent. How on earth are we to scrutinise whether taxpayers are getting value for money? Is the health service to be left to monitor itself?
My hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) discussed the £150 million—or is it £60 million?—of savings that the Bill will make. Nobody seems to know whether savings of £150 million, £60 million or somewhere in between will be made. One reason why the Minister does not want us to have the financial report proposed in new clause 2 is because he does not want us to see that somebody somewhere—perhaps him—got the figure wrong along the way. If we have that report we may discover the truth, which I suspect is that savings of neither £150 million nor even £60 million will be made.
It is hard to keep a straight face when the Government say that they will save money when they have been responsible for increasing spending on administration in the health service to figures as long as telephone numbers. It is unbelievable how spending on administration has risen.
The two new clauses are about accountability and openness. We have been round that circle many times and will undoubtedly be round it again because we never get straight answers and Ministers seek to avoid the issue. In my opinion, the Government do not want openness, they do not want democracy and they certainly do not want accountability.
Let me tell the Minister that people such as those whom I represent want openness, accountability and democracy in the health service; they want to know how their money is spent. The two new clauses will give the power to their Members of Parliament to obtain the answer to that question for them.

Mr. Nicholas Brown: Rather perceptively, my notes are headed "NCI", which I assume must stand for "No Conservative in sight". The British public are entitled to draw the pretty obvious conclusion from the fact that not a single member of the Conservative party has come here today to take part in an important debate to defend the Minister's point of view, except for the Minister himself.
I acknowledge that the Minister is here. He is ever present—apart from during the opening stages of the Bill, when he was unable to take part, and was helpfully described by the Parliamentary Under-Secretary of State, the hon. Member for Bolton, West (Mr. Sackville) as being ill-tempered and plague-ridden. It is not a description that I recognise of the Minister but, in fairness, his hon. Friend obviously knows him better.
The Minister no doubt hopes to cut an heroic figure among his parliamentary colleagues, standing alone at the Dispatch Box, holding back the forces of socialism, but the only nationalisation that is being undertaken here today has been undertaken by him, as he nationalises the functions of the regional health authorities by taking them in-house, under the direct control of the state, centralised under his direct personal control, inasmuch as the Secretary of State will allow him to exercise such control.
Our amendments are modest. They merely seek to hold the Minister accountable for his actions. Specifically, our new clause 2 seeks to hold the Minister accountable for the public money that he spends. That appears to me to be a perfectly reasonable proposition to put before the House. It has not originated in the ranks of the parliamentary Labour party alone. As my hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) rightly said: it is a perfectly sensible suggestion of the Audit Commission.
If the Government claim value for money, they have at least a duty to prove the point. Our new clause 2 would require them to do exactly that, no later than April 1997. We might not have felt it necessary to bring new clause 2 before the House had the Minister been more candid in Committee. Not only did he not appear to know the answers to the questions about the amount that he was spending, the amount that he was saving and the ultimate cost or saving to the taxpayer, but he offered us a moving feast of different figures.
In the first week—I accept that it was not the Minister's fault but that of the Under-Secretary, the hon. Member for Bolton, West—we were told that the savings would be £150 million, but the Committee was treated to that figure without any context. No doubt we were all supposed to be overawed by it and to think that it represented good value for money. We then discovered that the figure for savings in Wales was to be £3 million. My hon. Friend the Member for Cardiff, West (Mr. Morgan) calculated that, if one took the figure for Wales and applied a population factor to obtain an equivalent figure for England, one would obtain a figure of £50 million.
The Minister then told us that the true figure that the Government anticipated for eventual savings for England was £60 million. Therefore, more money was to be saved from England, per head of the population, than was to be saved in Wales.
The Minister knew enough about the figures to treat us to that information, but he was unable to tell us how the figures were calculated. He may have made them up, which is always a possibility, I suppose, or perhaps he had no intention of being candid with the Committee—he wished to keep the information to himself. I hesitate to suggest that his reasoning might have been that the information was commercially confidential, but nowadays, given the direction in which the national health service is going, frankly, one never knows. The Minister has not shared the information with the Committee. Labour Members believe that he should be required to share it with the House.
The Minister boasts about a saving. On Second Reading, the Bill was accompanied by a money resolution. That money resolution was permissive; its purpose was not to facilitate the saving of money but to facilitate the spending of money, so the Minister is effectively saying to the House that he will need to spend money on implementing the legislation.
No doubt the Minister's argument is that he spends money now to save it later. That is a perfectly reasonable argument to make; we simply require him to justify it, and we are entitled, as is the country, to draw our own conclusions from the fact that the Minister cannot justify it, or at least has not done so so far.
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If the Minister is unwilling to justify that argument, are we not entitled to draw some conclusions from the fact that he wishes that information to remain secret? Whatever it is, it is not good conduct; it is not good public administration; it is not parliamentary accountability. Indeed, the Minister is not even able to outline which functions will remain at the regional level, which will be devolved to local level and what the costs will be. If savings are to be made, I think that we are entitled to assume that some functions will be performed less well, perhaps not even performed at all. What functions? So far, the Minister has not said.
The case for new clause 2 appears to be well made in terms of parliamentary accountability and the good management of public finances alone. There is, however, an even stronger case to explore further—as we seek to do in new clause 1—the strength of the arguments that lie behind the Minister's nationalisation of the functions of regional health authorities.
The purpose of our new clause is to place on the Secretary of State a duty to lay before Parliament an annual report on the activities of the regional offices of the national health service executive in respect of the duties that will be transferred to them from the abolished regional health authorities. We are simply saying that the Secretary of State should be accountable to Parliament.
If the Government think that they are justified in proceeding in the way they suggest, let them explain their actions to the House. That appears to me to be a perfectly reasonable stance for any publicly elected representative to take. I am surprised that the Minister does not embrace the opportunity to boast about his achievements, instead of running away from the opportunity. That fills me with doubts and uncertainties about his true motivations.
Worries have been expressed by my hon. Friends. There are anxieties that the regional offices of the national health service executive will not have the resources or the expertise required to exercise effectively a range of functions—a subject that we explored in Committee, but which it is right to explore again with the Minister, as we received no satisfactory answers. Our fears are more deeply felt because, although staffing levels for those regions are to be similar, the size of the regions are not to be similar.
My hon. Friend the Member for Morley and Leeds, South cited the specific case of the North and Yorkshire region, as the Minister likes to think of two regions that have been added together. The Minister speaks to the House about efficiency savings. Those efficiency savings will not be found easily in the headquarters building.
As my hon. Friend the Member for Morley and Leeds, South said, there is spare space in Quarry house in Leeds. The region has as an objective the sale of the existing headquarters at Harrogate. There is also an existing headquarters building at Walkergate in Newcastle, and, as

if three headquarters were not enough for one region, the region intends to build a fourth new building in Durham city to add to its property holdings. I think that people would like the regional health authority to add to the primary and secondary health care it provides, not to its steadily burgeoning portfolio of office buildings.
We believe that the strategic regional overview of providing and purchasing decisions made by health authorities, GP fundholders and NHS trusts will be carried out in a thin and an episodic manner. My hon. Friend the Member for Lewisham, East (Mrs. Prentice) raised concerns about services which may not be purchased enthusiastically as priority services in the Government's new marketplace, but which are nevertheless important. My hon. Friend referred to HIV/AIDS and drug dependency units, and my hon. Friend the Member for Morley and Leeds, South made a similar point about mental health care. Those important areas may be downgraded rather than given the attention that they rightly deserve in the Government's new structure.
Although the argument stands true across the country, as we debated yesterday, I believe that there is a special and specific case for a region-wide overview of health care services in London. That case is extraordinarily well made, and the structures we will be invited to put in place later today will do absolutely nothing to help achieve it—although the Government seem to acknowledge the case for regional structures, albeit nationalised ones, elsewhere in the country.
Our proposed new clause requires the Minister to report to the House about the outcome of the structural reorganisation. We want to know about the savings, the safety nets and the important functions that are perhaps not being monitored and carried out as well as they should be. I think that it is perfectly reasonable for Members of Parliament from London to draw certain conclusions about a structure which is perfectly all right for regional planning areas but which is not all right for the nation's capital. The Minister's report—if there were to be one—would provide hon. Members with useful evidence for any case that they may wish to make.
There is a separate issue about training, including the co-ordination and strategic planning of nurses' training. In any market with a purchaser-provider split, it is often difficult to see what driving force will require the purchasing—that is the language that we must use these days—of nurses' training. The Royal College of Nursing has expressed some concerns. It believes that the ever-increasing demand for trained nurses will not be met, and it has pointed out that, since 1987, the number of training places for nurses in the national health service has been cut by 33 per cent. If that trend is being driven not by planning but by the marketplace, it is likely to continue.
Similar fears have been expressed about the operation of cancer registries and the organisation of cancer screening programmes. That important regional function will be nationalised by the Minister and carried out directly by his Department. It will be supervised by him personally, but I am not sure how reassuring that will be for those who expect the programme to be provided by a regional health authority with clinical decision-making and health care priorities—not driven by the political imperatives which drive Ministers.
My hon. Friend the Member for Stockport (Ms Coffey) drew attention to very important regional level public health initiatives. Where will they figure in the Government's marketplace? The Minister is effectively nationalising the people in charge, as the Bill transfers regional directors of public health from the employment of the NHS to the civil service. Regional directors will be not officials with a duty of responsibility to the general public but civil servants with a duty of responsibility to the Minister which, as we have discovered time and again in this place, is quite a different matter.
The British Medical Association has written to all hon. Members who served on the Committee expressing its concern that the resulting restrictions will curb the necessary freedom of public health officials to speak out, even if it is inconvenient to the Government. It is very difficult for civil servants to do that, because it constitutes a breach of the Official Secrets Act. I suspect that the Minister would be the first to invoke such legislation if it were in his interests to do so.
That is the sort of behaviour that one would expect of a former vice-chairman of the Conservative party. I see that the Minister is flinching; I thought that he would take it as a compliment, but he obviously considers it an insult to be accused of being an official of the Conservative party.

Sir Fergus Montgomery: Deputy chairman.

Mr. Brown: I am reminded by the hon. Member for Altrincham and Sale, who graces us with his presence, that the Minister was a deputy chairman of the Conservative party. The hon. Gentleman is clearly taking a close interest in health care provision, and I will move on to facilities for the elderly later. The hon. Gentleman has told me that he has reached the age of retirement, and I for one will miss him very much, because he is my pair. I think that the laws of supply and demand may work against me in the next Parliament, so I will miss him more than he thinks.
Before turning to those important considerations, I raise again the question of the siting of junior doctors' contracts. As the Minister would be the fast to acknowledge, junior doctors are the cornerstone of secondary health care. The Committee spent some time trying to explore with the Minister where the contracts of junior doctors would be located—would they be held by individual trust hospitals or by a consortia of trust hospitals, or would they be nationalised along with other regional functions and held by the state?
It was clear to me at the beginning of the Committee process that the Minister did not know the answer to that question. By the end of the process, he had told us that the contracts would be held at a regional level for the time being, and that the situation would be considered further. The BMA was concerned that, if the contracts were held at trust level, the necessary rotation of junior doctors would be affected, and training might not be completed.
It was clear to Committee members that the Government toyed with the idea of having a consortia of hospital trusts—a consortia of providers—hold the contracts. From the Government's point of view, it is perfectly rational to consider that proposal. Junior doctors are providers of health care, and it fits with the Government's purchaser-provider philosophy that the contracts should be held by the provider. When the

Government wish to sell off the hospitals to the private sector, the doctors and their contracts will go with them. Having the state hold the contracts at a regional level cuts across the market-based philosophy which is behind the rest of the Government's health care reforms.
The Government may be retreating from the original structures that constituted their great vision in the mid-1980s when they embarked on this stupidity. That is one possible explanation for their change in approach. We require the Secretary of State to come back to Parliament with a report which sets out whether the restructuring has succeeded. That is the key proposition in new clause 1.
My hon. Friends have raised correctly—although I accept that it is tangential to the main thrust of the argument—the question of involving universities and medical schools in planning decisions. Moneys are transferred from the Department of Education to the Department of Health. The Bill removes the statutory position which was enacted only recently.
The National Health Service and Community Care Act 1990 enabled universities and medical schools to participate in planning and decision-making at regional level. It is perfectly right that we should seek from the Government an explanation as to how the new interface is to work and to require, as we do in new clause 1, the Government to report to Parliament about the effectiveness of the new arrangements.
My hon. Friend the Member for Lewisham, East raised the separate issue of membership of health authorities and the Minister repeated the assurance which I understood him to have given in Committee: that, if a medical school or a dental school was involved, the appropriate person would be considered for membership of the health authority.
6 pm
The Minister told us something about the structures of the health authorities and the nature of the people who are to serve upon them, but from my point of view and that of other members of the Committee, that was not enough. He did not tell us about the rest of the composition of the health authority.
Which other professionals are to be involved and how are the laity to he chosen? Who are they to he? Perhaps Conservative Members are absent from the debate because they are encouraging their friends and relatives and people of equal virtue to fill in their application forms to apply for the new lay posts. Perhaps they have a head start on the rest of the nation, and are trying to get in before the Nolan committee reports. Who knows? I would accept any explanation that the Minister was willing to give the House—perhaps "accept" is putting it too strongly: I would at least listen to it charitably.
In any event, new clause 1 would require the Minister to report to Parliament on how the structures were working and to defend his decisions when they turned out to be perhaps politically motivated or even sordid.
The Committee was worried about the co-ordination of vocational training for general practitioners—again that is not easily purchased in the marketplace—and who would undertake responsibility for GP fundholders. We did riot think it right that that function should he handed over to health authorities. That could not he done easily, as health authorities are responsible for the non-fundholders, and in the Secretary of State's new quasi-market, fundholders


and health authorities are supposed to be competing purchasers, no longer co-operating but fighting over patients—presumably the ones who are not ill, as they are the ones who are worth having in the new marketplace.
Finally, the question has been raised and not satisfactorily answered as to how on earth hon. Members are to get parliamentary questions answered. The Minister already says that information is not held centrally, and hints that it is available somewhere. We have welters of answers saying exactly that. He suggests that we are not getting answers because we are not framing the questions properly.
In the spirit of all-party co-operation, I sought from the Minister advice as to how to phrase questions. The example I cited was, how should I phrase a question to discover how many hospitals there were in the country—hospitals for which he is directly responsible to the House? I asked the Minister how many hospitals there are, how many had closed and how many he is planning to close. He said that planning to close a hospital was a hypothetical question. One assumes that there is still some planning in the Department of Health, and that not everything has been thrown to the market.

Mr. Kevin Hughes: Perhaps, when he is tabling questions, my hon. Friend ought to go back to basics and ask the question, what is a hospital? [Interruption.] If he starts from there and he gets an answer to that question, he may be able to progress to other questions to which he would like answers.

Mr. Brown: My right hon. Friend the Member for Derby, South (Mrs. Beckett) advises me that the answer to such a question would probably be that the information is not held centrally. The perfectly reasonable information that I was trying to extract from the Minister was: how many hospitals are there in Britain, how many have closed, and how many is he planning to close?
Perhaps, in a certain sense, planning is hypothetical, but Ministers have shared their plans with the House before in a candid way and in a spirit of openness and willingness to discuss, perhaps even learn and to listen to suggestions from others. In my experience, however, whenever the Minister suggests closing a hospital, the local halls fill up with citizens who are worried that their hospital will be taken away and most people are against it, which seems more rational that the Minister might expect.
Not only is he unwilling to share information with us about which hospitals he is planning to close: he goes further in trying to conceal information by saying, as my hon. Friend for Doncaster, North (Mr. Hughes) has just pointed out, that he cannot answer the question, "What is a hospital?" That is Jesuitical in the extreme.
The Minister gave us no definition of a hospital. The Minister of State is supposed to hold an important office in the national health service, and he does not know what a hospital is. If the Minister does not know what a hospital is, how much confidence can we have in the rest of his legislation? Surely the Minister's lack of knowledge on a pretty fundamental and elementary point cannot reassure my hon. Friends or, indeed, Conservative Members.
How reassured is the hon. Member for Altrincham and Sale (Sir F. Montgomery) that the Minister of State does not know what a hospital is? I have heard the hon. Gentleman

speak eloquently about hospitals in his constituency. The hon. Gentleman has never had any difficulty in defining what he wanted kept open and wanted the Department to support rather than do down. The same is true of many Conservative Members. Surely they should join us in the Lobby tonight and support our proposition, which at least holds the Minister of State to account, and might even in future require him to explain what a hospital is.

Mr. Malone: We had an admission from the hon. Member for Doncaster, North (Mr. Hughes) that we had run round the same course many times before during the debate. That was two hours ago. He said that we had already run round the course 47 times. Let me say to the hon. Member for Newcastle upon Tyne, East (Mr. Brown) that we gave up running round it and started to ramble across it at will during the past 30 minutes or so.
I shall concentrate on new clause 2, which I did not deal with in my opening remarks, as it was not touched on by the right hon. Member for Derby, South (Mr. Beckett). If Opposition Members were looking for proof that the savings from the Bill will actually be delivered, I am sorry to tell them from a reading of their amendment they will not get it from that.
The amendment seeks to compare spending in 1995–96 and 1996–97. As I made clear in Committee, the savings will be made over a slightly longer time scale into 1997–98. We made all the figures perfectly clear in Committee, but I shall return to them for the purpose of absolute clarity during my short wind-up speech.
Savings are already being made from slimming down regional health authorities in preparation for the transition to regional offices. For example, RHA core staffing has already fallen from nearly 7,900 in July 1992 to about 2,600 in March 1994. Savings are also being made from the integration of the work of DHAs and FHSAs, and in total we expect savings approaching £60 million to be made in 1995–96. There is no great mystery about what will happen thereafter. By 1997–98, when the new structure is fully implemented, the savings will rise to nearly £150 million net per year.
Opposition Members asked how those savings are to be broken down. More than £100 million-worth of the total saving results from the abolition of RHAs and the consequent reduction and overlap of work between the central Department and the regions. The remainder is due to the replacement of DHAs and FHSAs with health authorities. As for savings in departmental running costs, savings secured from the elimination of functions that currenty overlap between regional health authorities and the NHS executive will also contribute to the saving of some £50 million in the running costs of the Department of Health to be made by 1997–98.
The hon. Member for Morley and Leeds, South (Mr. Gunnell) raised a point that was also raised in Committee, asking whether savings would stay in the region concerned. In the case of certain savings, the answer is yes. All RHA spending, except the amount to be transferred to the Department of Health administration vote for the running costs of the regional offices, will have been devolved to the districts in the region, and will form part of their baselines before decisions are made about allocations to health authorities for 1996–97.
That relates to the direct part of the spending; as I said in Committee, any other savings that accrue will be available for general health needs. They will be spent on patients, and will be allocated in the normal way.
New clause 2 is intended to ensure that savings are delivered. The annual departmental report—which, as I said earlier, is a Command Paper and is laid before Parliament—describes in detail the Department's expenditure and activities, including all its responsibilities and all major developments during the previous year. In future, it will also include the effects of the abolition of RHAs. It will be possible to quantify savings, and the House will have an opportunity to consider them in detail.
The hon. Member for Don Valley (Mr. Redmond) apologised for not having been present at the beginning of the debate; no doubt, if he ever returns to the Chamber, he will apologise again for not having been present at the end.
The hon. Gentleman referred to his own experience of the health service, and described it as extremely good. Let me point out that it is no use Opposition Members always saying that the health service in general is useless—as they do in the House—and then, when narrating their own experiences, saying that it is good. I hope that their experience of the service is coloured by what happens to them when they have to use it.
The hon. Member for Lewisham, East (Mrs. Prentice) made a point about London planning. Health care in London—which was debated at length yesterday—is currently changing: the existence of the London implementation group, which was created to serve a time-limited purpose, is drawing to its conclusion. The hon. Lady feared that there might not be enough drive to ensure proper provision and a proper strategy for London's health care, but I assure her that there will.
I should point out to the hon. Lady that the organisational structure of London's health service is now much simpler than it was; its former complexity led to the establishment of the implementation group. The four regional health authorities have become two, and, as part of the move to the new, streamlined regional structure, they now incorporate the work of the former outposts.
All but one or two providers of health care will be trusts by 1 April, including most of the former special health authorities. The health authorities have been brought together to form commissioning agencies, responsible for assessing needs and ensuring that the right balance of services is available in both hospital and community in each area. We also expect a considerable increase in the number of GP fundholders in inner London, with an extension of the 14 per cent. of the population who are already covered to some 24 per cent. by 1 April.
The role of the London implementation group is now largely completed, except in the case of primary health care: the primary care support force and the primary care

forum will remain. There is, indeed, a proper London perspective on health matters, and a much simpler structure which will enable that perspective to be implemented.

Mr. Simon Hughes: Will the Minister give way?

Mr. Malone: The hon. Gentleman has not participated so far, and I was on the point of finishing the speech.

Mr. Hughes: I was not a member of the Standing Committee.

Mr. Malone: As the hon. Gentleman points out, he did not participate in the Committee stage, either.

Mr. Hughes: Why?

Mr. Malone: I shall not go into that, but we missed the presence of the hon. Gentleman's party. I understand that its members were not very excited about making an appearance.

Mr. Hughes: On a point of order, Mr. Deputy Speaker. [Interruption.] It is a genuine point of order for the Chair. Is it correct for the Minister to assert that members of my party were not represented in the Standing Committee, given that we were not nominated?

Mr. Deputy Speaker (Mr. Michael Morris): That is nothing to do with the Chair.

Mr. Malone: I am obliged to you, Mr. Deputy Speaker. My understanding is that, if members of the hon. Gentleman's party had wished to secure a place on the Committee, they would have been entitled to do so; but they did not take advantage of that entitlement. No doubt the hon. Gentleman can complain to those who manage his party's business affairs, but it is a bit late for him to raise the matter on Report.

Mr. Deputy Speaker: Order. I have already made it clear that this has nothing to do with either the Chair or the debate.

Mr. Malone: You are quite right, Mr. Deputy Speaker. I shall speak to the hon. Gentleman privately after the debate, so that he is certain about the position.
I think that we have made it clear that there will be sufficient means of examining the savings generated by the reforms. The information will be available in the normal departmental report, which will be discussed in Parliament. Both new clauses are unnecessary, and if the Opposition choose to press them to a vote, I shall ask the House to reject them.

Ms Coffey: With the leave of the House, Mr. Deputy Speaker—

Mr. Deputy Speaker: Order. I think that the Minister has already sat down. Unless the hon. Lady wishes to make a speech—

Ms Coffey: I simply wish to ask, with the House's permission—

Mr. Deputy Speaker: Order. The hon. Lady must resume her seat. She may make another speech if she


wishes to do so, but the Minister has finished his speech, and she therefore cannot intervene. Perhaps she will wait until a bit later.

Ms Coffey: rose—

Mr. Deputy Speaker: Order. If the hon. Lady is to speak, she will need the leave of the House.

Hon. Members: No.

Ms Coffey: I rise to speak because—

Mr. Deputy Speaker: Order. Did I hear a no? Has the hon. Lady the leave of the House? [HON. MEMBERS: "Yes."] I think she has.

Ms Coffey: Thank you, Mr. Deputy Chairman.

Mr. Deputy Speaker: Order. I must be addressed as "Mr. Deputy Speaker", or referred to as the Chair.

Ms Coffey: My apologies, Mr. Deputy Speaker.
In my earlier speech, I asked some specific questions. I asked, for instance, who would inspect and monitor the community programme for the mentally handicapped. That is a serious issue, and I am deeply disappointed that the Minister did not refer to it: given that the RHAs are to be abolished, it is very pertinent.

Question put, That the clause be read a Second time:—

The House divided: Ayes 242, Noes 283.

Division No. 80]
[6.17 pm


AYES


Abbott, Ms Diane
Cann, Jamie


Adams, Mrs Irene
Chidgey, David


Ainger, Nick
Chisholm, Malcolm


Allen, Graham
Church, Judith


Alton, David
Clapham, Michael


Armstrong, Hilary
Clarke, Eric (Midlothian)


Ashton, Joe
Clarke, Tom (Monklands W)


Austin-Walker, John
Clelland, David


Banks, Tony (Newham NW)
Clwyd, Mrs Ann


Barnes, Harry
Coffey, Ann


Barron, Kevin
Connarty, Michael


Battle, John
Corbett, Robin


Bayley, Hugh
Cousins, Jim


Beckett, Rt Hon Margaret
Cox, Tom


Beith, Rt Hon A J
Cummings, John


Bell, Stuart
Cunliffe, Lawrence


Benn, Rt Hon Tony
Cunningham, Jim (Covy SE)


Bennett, Andrew F
Cunningham, Rt Hon Dr John


Bermingham, Gerald
Dalyell.Tam


Berry, Roger
Darling, Alistair


Betts, Clive
Davidson, Ian


Blair, Rt Hon Tony
Davies, Bryan (Oldham C'tral)


Blunkett, David
Davies, Rt Hon Denzil (Llanelli)


Boateng, Paul
Davies, Ron (Caerphilly)


Bradley, Keith
Davis, Terry (B'ham, H'dge H'l)


Bray, Dr Jeremy
Denham, John


Brown, Gordon (Dunfermline E)
Dewar, Donald


Brown, N (N'c'tle upon Tyne E)
Dixon, Don


Bruce, Malcolm (Gordon)
Dobson, Frank


Burden, Richard
Donohoe, Brian H


Byers, Stephen
Dowd, Jim


Cabom, Richard
Dunnachie, Jimmy


Callaghan, Jim
Eagle, Ms Angela


Campbell, Mrs Anne (C'bridge)
Eastham, Ken


Campbell, Ronnie (Blyth V)
Enright, Derek


Campbell-Savours, D N
Etherington, Bill


Canavan, Dennis
Evans, John (St Helens N)





Fatchett, Derek
Marshall, Jim (Leicester, S)


Field, Frank (Birkenhead)
Martin, Michael J (Springburn)


Fisher, Mark
Maxton, John


Flynn, Paul
Meacher, Michael


Foster, Rt Hon Derek
Michael, Alun


Foulkes, George
Michie, Bill (Sheffield Heeley)


Fraser, John
Michie, Mrs Ray (Argyll & Bute)


Fyfe, Maria
Milburn, Alan


Galbraith, Sam
Miller, Andrew


Galloway, George
Mitchell, Austin (Gt Grimsby)


Gapes, Mike
Moonie, Dr Lewis


Gilbert, Rt Hon Dr John
Morgan, Rhodri


Godman, Dr Norman A
Morley, Elliot


Golding, Mrs Llin
Morris, Rt Hon Alfred (Wy'nshawe)


Graham, Thomas
Morris, Estelle (B'ham Yardley)


Grant Bernie (Tottenham)
Morris, Rt Hon John (Aberavon)


Griffiths, Nigel (Edinburgh S)
Mowlam, Marjorie


Griffiths, Win (Bridgend)
Mudie, George


Grocott, Bruce
Mullin, Chris


Gunnell John
Murphy, Paul


Hain, Peter
Oakes, Rt Hon Gordon


Hall, Mike
O'Brien, Mike (N W'kshire)


Hanson, David
O'Brien, William (Normanton)


Harvey, Nick
O'Hara, Edward


Henderson, Doug
Olner, Bill


Heppell, John
O'Neill, Martin


Hill, Keith (Streatham)
Orme, Rt Hon Stanley


Hinchlirffe, David
Parry, Robert


Hoey, Kate
Patchett, Terry


Hogg, Norman (Cumbernauld)
Pearson, Ian


Home Robertson, John
Pendry, Tom


Hood, Jimmy
Pickthall, Colin


Hoon, Geoffrey
Pike, Peter L


Howarth, George (Knowsley North)
Pope, Greg


Hughes, Kevin (Doncaster N)
Powell, Ray (Ogmore)


Hughes, Robert (Aberdeen N)
Prentice, Bridget (Lew'm E)


Hughes, Roy (Newport E)
Prentice, Gordon (Pendle)


Hughes, Simon (Southwark)
Primarolo, Dawn


Hutton, John
Purchase, Ken


Illsley, Eric
Raynsford, Nick


Jackson, Glenda (H'stead)
Redmond, Martin


Jackson, Helen (Shef'ld, H)
Reid, Dr John


Jamieson, David
Rendel, David


Jones, Ieuan Wyn (Ynys Mon)
Robertson, George (Hamilton)


Jones, Jon Owen (Cardiff C)
Robinson, Geoffrey (Co'try NW)


Jones, Lynne (B'ham S O)
Roche, Mrs Barbara


Jones, Martyn (Clwyd, SW)
Rogers, Allan


Jones, Nigel (Cheltenham)
Rooker, Jeff


Jewell, Tessa
Rooney, Terry


Keen, Alan
Ross, Ernie (Dundee W)


Kennedy, Jane (Lpool Brdgn)
Rowlands, Ted


Kilfoyle, Peter
Ruddock, Joan


Lewis, Terry
Salmond, Alex


Liddell, Mrs Helen
Sedgemore, Brian


Litherland, Robert
Sheerman, Barry


Livingstone, Ken
Shore, Rt Hon Peter


Lloyd, Tony (Stretford)
Short, Clare


Llwyd, Elfyn
Skinner, Dennis


Loyden, Eddie
Smith, Andrew (Oxford E)


Lynne, Ms Liz
Smith, Chris (Isl'ton S & F'sbury)


McAllion, John
Smith, Llew (Blaenau Gwent)


McAvoy, Thomas
Soley, Clive


McCartney, Ian
Spearing, Nigel


Macdonald, Calum
Spellar, John


McFall, John
Steinberg, Gerry


McKelvey, William
Stevenson, George


Mackinlay, Andrew
Stott, Roger


McMaster, Gordon
Strang, Dr. Gavin


McNamara, Kevin
Straw, Jack


MacShane, Denis
Sutcliffe, Gerry


McWilliam, John
Taylor, Mrs Ann (Dewsbury)


Madden, Max
Taylor, Matthew (Truro)


Maddock, Diana
Timms, Stephen


Mahon, Alice
Tipping, Paddy


Marek, Dr John
Touhig, Don


Marshall, David (Shettleston)
Trimble, David






Turner, Dennis
Williams, Alan W (Carmarthen)


Vaz, Keith
Wilson, Brian


Walker, Rt Hon Sir Harold
Wise, Audrey


Walley, Joan
Worthington, Tony


Wardell, Gareth (Gower)
Wray, Jimmy


Wareing, Robert N
Wright Dr Tony


Welsh, Andrew



Wicks, Malcolm
Tellers for the Ayes:


Wigley, Dafydd
Mr. Peter Mandelson and Mr. Joe Benton.


Williams, Rt Hon Alan (Sw'n W)





NOES


Ainsworth, Peter (East Surrey)
Day, Stephen


Aitken, Rt Hon Jonathan
Deva, Nirj Joseph


Alexander, Richard
Devlin, Tim


Alison, Rt Hon Michael (Selby)
Dicks, Terry


Allason, Rupert (Torbay)
Douglas-Hamilton, Lord James


Amess, David
Dover, Den


Arbuthnot, James
Duncan, Alan


Arnold, Jacques (Gravesham)
Duncan Smith, Iain


Ashby, David
Dunn, Bob


Atkins, Robert
Durant, Sir Anthony


Atkinson, David (Bour'mouth E)
Dykes, Hugh


Atkinson, Peter (Hexham)
Eggar, Rt Hon Tim


Baker, Nicholas (North Dorset)
Elletson, Harold


BakJry, Tony
Evans, David (Welwyn Hatfield)


Bates, Michael
Evans, Jonathan (Brecon)


Batiste, Spencer
Evans, Nigel (Ribble Valley)


Bellingham, Henry
Evans, Roger (Monmouth)


Bendall, Vivian
Evennett, David


Beresford, Sir Paul
Faber, David


Biffen, Rt Hon John
Fabricant, Michael


Body, Sir Richard
Field, Barry (Isle of Wight)


Bonsor, Sir Nicholas
Fishburn, Dudley


Booth, Hartley
Forman, Nigel


Boswell, Tim
Forsyth, Rt Hon Michael (Stirling)


Bottomley, Peter (Eltham)
Forth, Eric


Bottomley, Rt Hon Virginia
Fox, Dr Liam (Woodspring)


Bowden, Sir Andrew
Fox, Sir Marcus (Shipley)


Bowis, John
Freeman, Rt Hon Roger


Boyson, Rt Hon Sir Rhodes
French, Douglas


Brandreth, Gyles
Fry, Sir Peter


Brazier, Julian
Gale, Roger


Bright, Sir Graham
Gallie, Phil


Brooke, Rt Hon Peter
Gardiner, Sir George


Brown, M (Brigg & Cl'thorpes)
Garnier, Edward


Browning, Mrs Angela
Gill, Christopher


Bruce, Ian (Dorset)
Gillan, Cheryl


Burns, Simon
Goodlad, Rt Hon Alastair


Burt, Alistair
Goodson-Wickes, Dr Charles


Butcher, John
Gorman, Mrs Teresa


Butler, Peter
Gorst, Sir John


Butterfill, John
Grant Sir A (SW Cambs)


Carlisle, John (Luton North)
Greenway, Harry (Ealing N)


Carlisle, Sir Kenneth (Lincoln)
Greenway, John (Ryedale)


Carrington, Matthew
Griffiths, Peter (Portsmouth, N)


Carttiss, Michael
Grylls, Sir Michael


Cash, William
Gummer, Rt Hon John Selwyn


Channon, Rt Hon Paul
Hague, William


Chapman, Sydney
Hamilton, Neil (Tatton)


Clappison, James
Hampson, Dr Keith


Clark, Dr Michael (Rochford)
Hanley, Rt Hon Jeremy


Clarke, Rt Hon Kennelh (Ru'clif)
Hannam, Sir John


Clifton-Brown, Geoffrey
Harris, David


Colvin, Michael
Haselhurst, Alan


Congdon, David
Hawkins, Nick


Conway, Derek
Hawksley, Warren


Coombs, Anthony (Wyre For'st)
Hayes, Jerry


Coombs, Simon (Swindon)
Heald, Oliver


Cope, Rt Hon Sir John
Heath, Rt Hon Sir Edward


Couchman, James
Heathcoat-Amory, David


Cran, James
Hendry, Charles


Currie, Mrs Edwina (S D'by'ire)
Hicks, Robert


Curry, David (Skipton & Ripon)
Higgins, Rt Hon Sir Terence


Davies, Quentin (Stamford)
Hill, James (Southampton Test)





Hogg, Rt Hon Douglas (G'tham)
Pawsey, James


Horam, John
Peacock, Mrs Elizabeth


Howard, Rt Hon Michael
Pickles, Eric


Howarth, Alan (Strat'rd-on-A)
Porter, Barry (Wirral S)


Howel, Rt Hon David (G'dford)
Porter, David (Waveney)


Howell, Sir Ralph (N Norfolk)
Portillo, Rt Hon Michael


Hughes, Robert G. (Harrow West)
Powell, William (Corby)


Hunt, Sir John (Ravensbourne)
Redwood, Rt Hon John


Hunter, Andrew
Renton, Rt Hon Tim


Hurd, Rt Hon Douglas
Richards, Rod


Jack, Michael
Riddick, Graham


Jackson, Robert (Wantage)
Rifkind, Rt Hon Malcolm


Jenkin, Bernard
Robathan, Andrew


Jessel, Toby
Robertson, Raymond (Ab'd'n S)


Jones, Gwilym (Cardiff N)
Robinson, Mark (Somerton)


Jones, Robert B (W Hertfdshr)
Roe, Mrs Marion (Broxbourne)


Kellett-Bowman, Dame Elaine
Rowe, Andrew (Mid Kent)


Key, Robert
Rumbold, Rt Hon Dame Angela


King, Rt Hon Tom
Ryder, Rt Hon Richard


Kirkhope, Timothy
Sackville, Tom


Knapman, Roger
Sainsbury, Rt Hon Sir Timothy


Knight, Mrs Angela (Erewash)
Scott, Rt Hon Sir Nicholas


Knight, Greg (Derby N)
Shaw, David (Dover)


Knight, Dame Jill (Bir'm E'st'n)
Shaw, Sir Giles (Pudsey)


Knox, Sir David
Shephard, Rt Hon Gillian


Kynoch, George (Kincardine)
Shepherd, Colin (Hereford)


Lait, Mrs Jacqui
Shepherd, Richard (Aldridge)


Lang, Rt Hon Ian
Shersby, Michael


Lawrence, Sir Ivan
Skeet, Sir Trevor


Legg, Barry
Smith, Tim (Beaconsfield)


Leigh, Edward
Soames, Nicholas


Lennox-Boyd, Sir Mark
Speed, Sir Keith


Lester, Jim (Broxtowe)
Spicer, Sir James (W Dorset)


Lidington, David
Spicer, Michael (S Worcs)


Lightbown, David
Spink, Dr Robert


Lilley, Rt Hon Peter
Spring, Richard


Lloyd, Rt Hon Sir Peter (Fareham)
Sproat, Iain


Lord, Michael
Squire, Robin (Homchurch)


Luff, Peter
Stanley, Rt Hon Sir John


Lyell, Rt Hon Sir Nicholas
Steen, Anthony


MacGregor, Rt Hon John
Stern, Michael


MacKay, Andrew
Stewart, Allan


McLoughlin, Patrick
Streeter, Gary


McNair-Wilson, Sir Patrick
Sumberg, David


Madel, Sir David
Sweeney, Walter


Maitland, Lady Olga
Sykes, John


Malone, Gerald
Tapsell, Sir Peter


Mans, Keith
Taylor, Ian (Esher)


Marland, Paul
Taylor, John M (Solihull)


Marlow, Tony
Temple-Morris, Peter


Marshall, John (Hendon S)
Thomason, Roy


Marshall, Sir Michael (Arundel)
Thompson, Sir Donald (C'er V)


Martin, David (Portsmouth S)
Thompson, Patrick (Norwich N)


Mates, Michael
Thornton, Sir Malcolm


Mawhinney, Rt Hon Dr Brian
Thurnham, Peter


Merchant Piers
Townsend, Cyril D (Bexl'yh'th)


Mills, Iain
Tracey, Richard


Mitchell, Andrew (Gedling)
Tredinnick, David


Mitchell, Sir David (NW Hants)
Trend, Michael


Moate, Sir Roger
Trotter, Neville


Monro, Sir Hector
Twinn, Dr Ian


Montgomery, Sir Fergus
Vaughan, Sir Gerard


Nelson, Anthony
Walden, George


Neubert, Sir Michael
Walker, A Cecil (Belfast N)


Newton, Rt Hon Tony
Walker, Bill (N Taysrde)


Nicholls, Patrick
Waller, Gary


Nicholson, David (Taunton)
Wardle, Charles (Bexhill)


Nicholson, Emma (Devon West)
Waterson, Nigel


Norris, Steve
Watts, John


Onslow, Rt Hon Sir Cranley
Whitney, Ray


Oppenheim, Phillip
Whittingdale, John


Ottaway, Richard
Widdecombe, Ann


Page, Richard
Wiggin, Sir Jerry


Paice, James
Wilkinson, John


Patnick, Sir Irvine
Wilshire, David


Patten, Rt Hon John
Winterton, Mrs Ann (Congleton)






Winterton, Nicholas (Macc'fld)
Young, Rt Hon Sir George


Wolfson, Mark
Tellers for the Noes:


Wood, Timothy
Mr. Bowen Wells and Mr. David Willetts.


Yeo, Tim

Question accordingly negatived.

Schedule 1

AMENDMENTS

Mr. Malone: I beg to move amendment No. 3, in page 6, line 13, leave out from beginning to 'for' in line 14 and insert—
'3. Section 12 (supplementary provisions about health authorities) shall be renumbered as subsection (2) of that section and—
(a) before that subsection as so renumbered insert—
"(1) Every Health Authority shall make arrangements for securing that they receive from—
(a) medical practitioners, registered nurses and registered midwives; and
(b) other persons with professional expertise in and experience of health care,
advice appropriate for enabling the Health Authority effectively to exercise the functions conferred or imposed on them under or by virtue of this or any other Act.",
(b) in that subsection as so renumbered,'.
The amendment arises from a commitment that I made in Committee. I made it because of a general concern felt across the professions involved with medicine that their involvement in health authority decisions should not be left simply as a matter of good practice.
In response to a full debate in Committee, I made it clear that the amendment would not set out a rigid system of professional advisory committees, because that would simply mean rebuilding the existing structure, which has already proved to be inflexible and which does not encourage arrangements to be tailored to local needs. I made it clear that we would be introducing something new. The existing structure does not take account of the full range of health care professions that need to contribute to a health authority's work. Therefore, the Bill removes the existing regional and district committee structure.
The amendment will add force to draft health service guidelines entitled, "Professional Involvement in Health Authority Work", on which the Government are consulting. I referred to that in Committee and I am pleased to tell the House that there has been an excellent response to that consultation exercise. The Department has written to 92 organisations asking for their comments and it has circulated the draft guidance widely within the NHS community. A total of 57 responses have so far been received, the vast majority of which have been supportive. For example, the vice-president of the Royal College of Anaesthetists said:
The Royal College of Anaesthetists welcomes the guidance … The involvement of doctors and other professionals is essential for the proper planning, development and delivery of optimum health care for patients.
The executive secretary of the British Orthoptic Society welcomed the fact that
the importance of professional input into Health Authority work is recognised.
The Chartered Society of Physiotherapy said:
Broadly, we think the guidance is very helpful.

A consultant in old-age psychiatry from Southampton community health said:
I thought I should write and say how encouraged I was by this Executive Letter … We look forward to the implementation of this letter.
Several professional bodies, notwithstanding their welcome for the Government's guidance, have said that it is important to secure effective professional involvement over and above the guidance. It is to provide that force, which I recognised in Committee and which was referred to by many hon. Members on the Committee, that we tabled this amendment.
The guidelines are not rigid. They stress that models should be considered carefully but not copied unquestioningly. They do not prescribe in detail how professional involvement is to be achieved, but they leave in no doubt the importance of that involvement. The amendment will give additional authority to the guidelines by placing on each health authority a duty to make arrangements to ensure that appropriate professional advice is available to them at every stage. Exactly how that advice is obtained is left to individual health authorities to decide. That is where they need flexibility to adapt to local needs.
A general feeling was expressed that advice must come not just from doctors and nurses but from a range of professions associated with medicine such as physiotherapists, ophthalmic opticians, dentists, pharmacists and dietitians. That point is stressed in the draft guidelines and is made clear in the amendment.
Hon. Members will wish to know what arrangements will be made to ensure compliance with the new legislation and with the guidelines. Regional offices of the NHS executive will monitor individual health authorities closely, especially in the important early stage when arrangements are being set up. They will require that arrangements have a real impact on health authority work and that health authority employees can be confident of easy access to professional input as necessary for their work.
I hope that hon. Members will be reassured that the Secretary of State has powers under section 17 of the National Health Service Act 1977 to give directions to health authorities with which they must comply. The Government will be willing to use those powers if it becomes necessary to ensure that all health authorities implement the new duty effectively. I make that point specifically to underpin the Government's view and to ensure that our commitment to professional advice is not just written into statute but will become an effective and living element of the way in which health authorities work from day to day.
There is one further point, which is made clear in the guidelines but which I should like to take the opportunity to emphasise. The arrangements made must command the confidence of professions locally. In the Government's view, that will not be achieved if health authority management seek to control the agenda too tightly. Some concern has been expressed on that point, and it is that concern which I wish to answer.
It is important that arrangements are flexible enough to allow professionals to initiate discussion on issues of concern to them. One of the representations made by a number of people on the guidelines was: could only the health authority initiate such discussion, or could professional advice be offered if the professional


organisation wished to take that initiative? I can assure the House that all professionals will have the opportunity to initiate discussions on issues of concern to them. Arrangements will be firmly in place, supported by the amendment, to ensure that such concerns are seriously and carefully considered.
I am convinced that the amendment will give hon. Members and, more important, professions outside the reassurance that they need and have sought. Its purpose is to ensure that every authority does its work, and is seen properly to do so, by seeking professional advice. I give the House an undertaking that any authority that does not seek such advice or does not listen to it when it is volunteered and discussions are initiated will not be complying with the new statutory duty under the Bill.
I commend the amendment to the House. It fulfils a number of the concerns that were expressed by hon. Members in Committee. I hope that hon. Members who spoke on the matter will feel that it also fulfils the commitment that I gave in Committee to table a substantive amendment on Report to deal with those matters.

Mr. Kevin Hughes: The Government plan under the Bill to abolish local and regional advisory committees in England, but are leaving the national advisory framework for Wales in place. In Committee, we challenged the Government on that proposal. In response, they tabled the amendment.
The Government are making a clear statement in statute about the duty to recognise the importance of involving clinicians in the decision-making process. They apparently accept the importance of clinicians' involvement in the decision-making process in the NHS.
The Secretary of State was explicit on the point on Second Reading, when she said:
Sitting on boards is not the only way for professionals to be involved, nor is it sufficient."—[Official Report, 12 December 1994; Vol. 251, c. 642.]
In spite of those words, however, the Bill still contains a provision that abolishes the local advisory machinery. Therefore, although I welcome the Government's amendment, I can give it only a partial welcome. I am happy that the Government have given the consultation of clinicians a force in statute, which may offer health professionals some reassurance, but I cannot understand the decision to proceed with the abolition of the advisory machinery, which facilitates that consultation and which is proposed under the Bill.
6.45 pm
The local advisory machinery has wide support. The British Medical Association and the Royal College of Nursing have expressed concern about the proposed abolition. The alternative arrangements are still not totally clear. It is only one month since the NHS executive issued its draft guidelines on the matter. Health professionals and their associations have had little chance to consider the guidelines, which were issued well after the legislation abolishing the current machinery. Consultation on the draft is still continuing, so we may not have the final guidelines for some time. Indeed, the Minister told us earlier that he has received only 57 responses so far.
Although the Secretary of State talks about wanting an integral place for professional advice in the NHS structure, she cannot tell us what that structure might be.

She has hived off policy making to the NHS executive, and it is the executive, not the Secretary of State, that is making decisions.
The Secretary of State, therefore, is asking the House to abolish something, yet we are not clear what will replace it. That has been typical of the Government's approach throughout the passage of the Bill, which is vague and lacking in detail. The Royal College of Nursing has described the duty in the amendment as welcome, but a "poor replacement" for the present statutory advisory machinery because it does not specify how or at what level in an organisation such advice should be maintained. There must therefore be reservations about the amendment. Welcome though it is as a small move in the right direction, Labour Members feel that it does not go far enough.
The Government tabled the amendment to try to reassure professional organisations, but, as the BMA has made clear, without a formal structure to put before the House for consideration, opposition to the changes will inevitably remain.
The Government appear to justify the abolition of the current machinery on the grounds that, somehow, it is peripheral. Professional associations do not share that view. They have been very supportive of the machinery and are alarmed at the Government's decision to abolish it. We need an alternative if we are to be able to judge the merits of change. To proceed with the abolition of the current arrangements without providing an alternative does not appear to fit in with the Secretary of State's apparent commitment to the importance of professional involvement.
The amendment goes some way to ensuring compulsion to involve professionals, but Labour Members will want to be sure that the consultation is effective and real and that it is certain to be available to all levels in the NHS—locally, regionally and nationally. In that sense, the Government's proposals are a real disappointment.
Proper consultation is the only way to ensure effective allocation of resources. Health care purchasers will need to know which treatments are clinically effective and proven. They will need to know a good deal about new treatments before deciding to proceed with the development of those services locally. Members of the medical profession must be involved in the purchasing and development of health services if purchasing is to be effective.
Without the involvement of the professions in decision making, the efficiency that the Government claim to be pursuing will be difficult to achieve. Purchasing of services can be effective only if managers are aware of the clinical effectiveness of treatments, the difficulties that exist with services or units, the maintenance of quality standards and advice on new procedures and drugs that are available.
The amendment may go some way to reassuring health care professionals of the Government's intentions, and Labour Members are pleased with the Government's decision to move it, but health care professionals have also stressed the need for a formal mechanism for advice to ensure that the views of clinicians are heard at all levels in the NHS.
I very much regret that the Government, in spite of their fine words, do not think the matter sufficiently important to introduce it in statute, but I look forward to seeing the final guidelines from the NHS executive.

Mr. Gunnell: I shall add just a few comments to those that have been made.
The Minister will recall that I moved amendments in Committee that would have retained the present advisory system, which is working.
In Committee, the Minister said:
The guidelines make it absolutely clear that professional involvement is not an optional extra … Will this be a sticking plaster over a commitment or will it be something real that works on a practical, day-to-day level. I can assure him that it is the latter and that it is something that Ministers understand to be fundamental to health authority work.
He went on to say that another important point was that
the arrangements that are in place are not just tokenism. They do not just go through the motions. Those professional arrangements will have a real impact on health authority work and decision making. On some issues, professional input may be needed which covers several purchasers."—[Official Report, Standing Committee A ,7 February 1995; c. 152–3.]
The Minister gave some commitments, and my reaction is similar to that of my hon. Friend the Member for Doncaster, North (Mr. Hughes). The Minister has honoured his commitment but the amendment contains words that need to be firmed up. The consultation period on the draft guidelines, entitled "Professional Involvement in the Health Authority Work", is to end on 28 February. He has so far received 57 responses but I am sure that he will have more by that date, although it is not too far away. The BMA has told me that it has yet to send the Minister its response. That is probably true for nurses, too. Both groups welcome the amendment and are correct to commend it, but some words need further clarification.
The amendment refers to
advice appropriate for enabling the Health Authority effectively to exercise the functions conferred or imposed on them".
The question that must be asked is who decides the advice to be appropriate? Under the old system, medical advisory groups and other advisory committees representing various groups in the health service decided when they thought advice from them was appropriate. The committees would advise health authorities and, further up the scale, the Secretary of State on what they thought appropriate. In this instance, it is not clear who is to judge the appropriateness. If the Minister wishes to clarify the point, I should be pleased to give way.

Mr. Malone: I am glad to oblige the hon. Gentleman with a little textual analysis so that his mind may be set at rest. I am grateful to him for reporting to the House at such length the speech that I made in Committee. It would not be sensible to have written all that into the amendment, which I know he is not suggesting should have been done.
I direct the hon. Gentleman's attention specifically to the amendment. Proposed subsection (1) states:
Every Health Authority shall make arrangements for securing that they receive … appropriate advice
from various persons and groups. The reasonable interpretation is that health authorities have a statutory obligation to make arrangements "for securing" such advice. The fact that they shall "make arrangements" gives force to the amendment. The amendment goes on to

state what health authorities will get once they have made the arrangements. It includes in proposed subsection (1)(a) and (b) those to whom the health authority will look for the
advice appropriate for enabling the Health Authority effectively to exercise the functions conferred or imposed on them".
That goes to the heart of what the hon. Gentleman is saying.
The point is that health authorities must receive advice; it is not simply a matter of their seeking advice. It can be a two-way process: if the professions believe that they have advice that is appropriate, they will be able to tender it to the health authority. I hope that that helps the hon. Gentleman.

Mr. Gunnell: It is helpful, and the professionals involved will have to examine in detail what has been said. The amendment could have been interpreted to mean the subjects where the health authority felt that it was appropriate to have advice. If it in fact refers to when the profession feels that it is appropriate to have advice, the question that arises is what steps will the health authority take to get that advice? Will it set up something akin to an advisory committee? There is certainly a good number of advisory committees at the moment. We still seem to be at a flexible stage in deciding exactly what structure will prove acceptable.
The Minister has ensured that there is a statutory responsibility to get advice, but what structure within the medical profession will provide that advice? Will it, in a sense, be open season and that anyone who wants to give advice can do so? That would probably not be the most efficient way to proceed but, if a more limited structure were set up, we should need a model for involving the right professionals and professional groupings in the giving of advice. I am seeking merely to ensure that the professions are comfortable with the way in which advice can be offered. Let me cite a specific example.
We shortly expect the Secretary of State to make a statement on long-term care, about which there has been considerable speculation recently. She might be able to tell us tonight when we can expect it. We do not know whether her guidelines will leave a specific role for health authorities but, in commenting on what has so far emerged from the Department of Health, some people have said that health authorities will have a role in determining what they consider to be appropriate conditions for long-term care. I should have thought it was an issue in which some medical input was necessary. Such cases are often expensive so doctors might want to comment on individual cases as well as the category of people entitled to long-term care under the NHS. It is a very important issue, which is why we await the Secretary of State's statement with some interest.
I feel that the new arrangements mean that we might be getting closer to the position in the United States, where I lived and where it is essential to have medical insurance offering some hope of long-term care should one be struck with some dreadful, long-term, paralysing illness. However, very few people have a foolproof insurance policy. If we take the view that the health service will in future provide long-term care only if there is some hope of medical improvement or mediation, people will be in a very difficult position if they ever need life-long nursing care.
We await the Secretary of State's guidance with great interest, but this is just the sort of issue in which the medical profession will want to have an input, for individual cases or in terms of policy for an individual health authority. The question is, at what level should that input be? The Secretary of State might take the view that her guidance is sufficiently clear for there to be no need for medical input, but some matters still need to be clarified. If further clarification is forthcoming, I assume that it will be after the conclusion of the consultation period with the professionals on 28 February.
I join my hon. Friend the Member for Doncaster, North in welcoming the proposals. The professionals also welcome them but there are blurred edges which need to be clarified. We hope that when the full views of the professionals are known, the Minister will clarify the position. Perhaps there will be advice on structures for consultation. Perhaps he will make it clear that "appropriate advice" is advice that the professionals feel is appropriate, just as much as it is advice that the health authority or the regional office thinks is appropriate.

7 pm

Mr. John Heppell: In some ways, I am reassured that the amendment has no more clarity than most of the other proposals in the Bill. One of the things that has characterised the passage of the Bill is that the Minister has been unable to give us answers. It is always a case of, "Things will evolve", or, "You will hear about that in the future." In the same way, the amendment lacks clarity. It does not describe the mechanism or structure that will enable professional advice to be given to health authorities.
Like some of my hon. Friends, I have thought about the way in which advice should be given. I thought that it would be wrong if the health authority just picked a doctor whom it knew would go along with whatever view it decided. We would need to get together a number of doctors at local and at regional level so that they could offer their advice. I then thought, "What would we call the groups?" In the end, I thought that the groups could be called, as they are now, local advisory committees and regional advisory committees. If the Minister has other plans, perhaps he will spell them out to us.
The Minister gives the House a wrong perception when he talks about the people who have responded to his notice about guidelines. He talked about "a consultant". Throughout the Bill's passage, there has always been "a consultant in Newcastle" or "a doctor in Birmingham" to prove the Minister's point. The doctor says that whatever the Government are doing is right. I would like to read in detail all the responses from all the professional bodies. I suspect that they are saying, "Yes, we welcome the amendment, but we welcome it only because it is better than nothing." When the Bill began its passage through the House, the advisory committees were disappearing and nothing had been suggested to take their place.
I have here a briefing from the Royal College of Nursing, which says:
This amendment is being proposed in response to concerns about the Bill's abolition of professional advisory committees at district and regional levels … Whilst this improves the legislation, it does not specify how, or at what level within the organisation, such advice should be obtained. It is a poor replacement for the professional advisory machinery that currently exists.

That is fairly unambiguous. The Royal College of Nursing welcomes the fact that the Government are doing something in response to their concerns, but it does not welcome the changes. It would much prefer the old system to be in operation.
Nurses provide 80 per cent. of patient care, so there is a real case for saying that they should have some involvement in decisions about purchasing. Should they not have some involvement in determining how the money is spent? They probably have far more involvement than Members of Parliament and far more involvement than many of the people who sit on the boards. On Second Reading, the Secretary of State said:
We want professional advice to be integral in the new structure, and we want professional advice to become professional involvement."—[Official Report, 12 December 1994; Vol. 251, c. 643.]
I would welcome that; I would love to see professional involvement, because it does not happen at the moment.
On Second Reading and in Committee, I quoted the fact that of the 240 chairs of family health service authorities and district health authorities, more than half had interests in business, consultancy or finance. That was their background. Of the 240 chairs, only 15 have any sort of medical background. We must ask ourselves whether we are picking the right people. If we do not have on the boards people who have medical experience, we need to ensure that the advisory system is toughened up an awful lot more than would be the case under the amendment.
I know that the British Medical Association has not responded yet to the Minister. A BMA briefing makes the position clear. It says:
There should be comprehensive arrangements for medical advice and it is essential that some formal mechanism should be in place so that the views of doctors can be heard.
The word "formal" is underlined. We cannot leave it to the health authorities to make their own arrangements. As well as saying that advice should be sought, the mechanism and structure by which advice is sought should be spelt out in statute. If we do not have that mechanism and structure, there will be different systems across the country. Some of them may be adequate, but many will be bad.
I now turn to the factors that health authorities should take into account when they seek advice. If a health authority intended to purchase obstetric care, the consultant would advise on whether antenatal care, postnatal care and the delivery should be built into the contract. If a health authority was thinking of closing a hospital for the elderly, the GP should advise on the support services that would be needed to allow the elderly patients to live in the community.
When considering the transfer of prescribing responsibilities, the health authority would need advice on the interface between what should be prescribed by the hospital and what should be prescribed by the GP. Obviously, health authorities need advice on such matters. When considering a contract for prostate surgery, there would be discussions on whether use specialist urology surgeons or general surgeons with an interest in urology.
It is almost certain that medical advice would have an impact on every business and financial decision—every decision—made in a hospital. The Minister has missed an opportunity here, as he has missed so many opportunities in the Bill, to do something positive in terms of trying to ensure that the medical advice is adequate and available


to the health authorities. He could have taken such action, but he has not done so. With this amendment, as with the Bill generally, he has failed to grasp the opportunity in front of him.

Ms Coffey: What interests me about the amendment is proposed subsection (1), which says that health authorities shall make arrangements to ensure that they receive advice from
other persons with professional expertise in and experience of health care.
I wonder what that means. I welcome the fact that advice will be sought from medical practitioners, registered nurses and registered midwives, as is right and proper. However, some of my hon. Friends feel that if the Government had wanted the advice of such people to have a big impact, having them as full members of the health authority, with a vote, might have been a better way in which to achieve that aim.
Leaving that aside, the category covering
other persons with professional expertise in and experience of health care
is not very explicit. In fact, it is extremely vague. I wonder whether the Minister is considering involving users of health care at some point. Although I have a great deal of admiration and respect for professionals, they do not always know what is best. Sometimes, health care user groups have a perfectly valid and important point of view. If the Minister's intention is that
other persons with professional expertise in and experience of health care"—

Mr. Malone: Will the hon. Lady give way?

Ms Coffey: Of course.

Mr. Malone: Let me prick the hon. Lady's bubble, if I may, before we go too far down that line. The answer to her question, in general terms, is probably no. Proposed subsection 1(b) is drafted as widely as it is to take in the whole range of professionals. The Government did not wish to make an exclusive list. We were faced with the problem of certain professions and specialties emerging from time to time and describing themselves in different ways; so it would not have been wise to have been prescriptive. However, I would not try to suggest to the hon. Lady that the amendment would go beyond what it states to another area and cover, for example, areas which are perhaps already covered by community health councils, which are important for the user group to which she refers.

Ms Coffey: The amendment should cover other areas because although community health councils represent user groups, they do not represent every user group. User groups often change depending on the issues that arise, as I shall illustrate for the Minister.
The health commission in Stockport and—I think—the health care trust as well, which is the provider of the service, decided to change speech therapy from a school-based service to a clinic-based service. Since then, there have been horrendous difficulties in maintaining even a clinic-based service because of a certain underfunding of speech therapy and when speech therapists have gone on maternity leave, there has been no provision.
That move from a school to a clinic-based service has had enormous repercussions in the screening of children at nursery level, which, as Minister will be aware, is the best time for screening for possible speech difficulties which impact on children's educational needs. The service relies on parents to take children to clinics for appointments. I may add that, after two appointments, a parent is not offered a further appointment.
The difficulty that arises, as I am sure the Minister will acknowledge, is that a child with well-motivated parents will receive that speech therapy service, but a child whose parents have difficulties, sometimes with transport, because not every clinic which has a speech therapist is accessible to every parent, will not receive that service. In fact, in one of the most deprived areas of my constituency, there is no speech therapy provision at all in the local clinic. Essentially, that policy has caused difficulties for those children who are perhaps in most need of speech therapy.
If there had been an obligation on the health authority to consult a user group, parents and, indeed, nursery and primary school teachers, particular problems with that change in policy would have become evident. Since the health authority saw the change from its point of view—it is a cost-;saving exercise because, obviously, it is easier and cheaper to provide services in a clinic than to pay for speech therapists to visit schools—the policy was changed, which was unfortunate.
I put part of the problem down to the fact that the appropriate user group—teachers—was not consulted extensively, nor, probably, did the health authority see any reason to consult it extensively. I am not saying that the health authority did not take on board some of the comments made by head teachers, but because it had only to ask, the advice given was not viewed as statutory, and perhaps the health authority evaluated it differently.
7.15 pm
Another user group which will become increasingly important is that of carers, especially those who care for people who are mentally handicapped or mentally ill or, indeed, elderly parents at home. As my hon. Friend the Member for Doncaster, North (Mr. Hughes) pointed out, many aspects of health care are yet unresolved. One of the biggest unresolved issues is the separate responsibilities of the health authority and the local social services department to purchase health care for the elderly. There are no clear guidelines on that.
At the moment, the situation is manageable because the social services have money in their community care budgets to enable the purchase of that health care—although at the expense of other community care—and the health authorities are quite happy for that to continue. The carers, the users of that health care, are not currently involved in any part of the consultation process. The tension exists merely between the health authority and the local social services.
I am very concerned that, when that tension is resolved and local guidelines are drawn up—it is the Secretary of State's intention that local guidelines should be drawn up, issued and transparent—carers will not have any input. Often, the recipients of health care can tell professionals what will work and what will not work. In giving that advice, they can help to ensure that the available resources are effectively spent. History is littered with examples of professionals having good intentions of achieving a


certain objective which was not achieved because they failed to take into account something which could have been pointed out by the person who was supposed to receive the service.
It is most disappointing that the Minister does not feel that the health authority should be asked to make arrangements for securing advice from the users of health care. The community health council has an important role and a different experience from the people who use health care.
To give yet another example, the most difficult health care to deliver is in the most deprived areas where unemployment is high. It is a major challenge in health promotion to establish structures and strategies that will improve health in those areas. Indeed, health promotion in deprived areas all over the country is disappointing. If it is to be successful, health promotion must involve local people to find out how best screening can be provided or how best people may be persuaded to take advantage of health promotion programmes.
I would not want the Minister to think for an instant that I think that such promotion would permanently improve health, because it is related to poverty. There will be ill health as long as there is poverty. However, within the remit of health promotion, it is obviously important to ensure that it is used effectively among groups that do not currently take advantage of it, for whatever reason. The health professionals need to consult more extensively and understand why that is happening. Whether as users of health care or not, the health professionals must be consulted.
I am concerned about the fact that the Minister has not included that important user group. To use that over-used word "partnership", the professionals are part of the partnership for delivering a health strategy in a locality. Health authorities, trusts, local authorities and the users of health care are all involved in that partnership.
I was also surprised that the Minister said nothing about consulting local social services departments. Although such consultation occurs at officer level to a large extent, there is an enormous variation across the country. The local authority has a prime role in delivering health care through the public services and as an employer. In addition, with the health authority, it is a joint health care purchaser of services for elderly people.
Although the Government have made some welcome gestures towards consultation, it would have been more welcome if they had included the users of health care, and perhaps local authorities, to underline that partnership and the value of the role of health users and of the local authority as a health provider.

Mr. Malone: I shall address briefly some of the points that have been raised during the debate. I am grateful even for the grudging response from several Opposition Members who I thought looked at me sceptically in Committee and probably thought, "He'll never bring a detailed amendment before the House on Report." However, I am delighted to honour the undertaking that I gave in Committee.
I understand that the amendment does not go far enough. It was not designed to address concerns about board membership and making that prescriptive. It is therefore hardly surprising that I am going to fail the

expectations or wishes of the hon. Members for Doncaster, North (Mr. Hughes) and for Morley and Leeds, South (Mr. Gunnell) on those points.
Opposition Members raised several important points about the detail and structure and I draw their attention to the draft guidelines which have been issued for consultation. No fewer than seven principles should inform local arrangements by health authorities for involving professionals. These will vary widely across the range. It is not right to say that the rather rigid and formalistic structure which is not going to be reiterated in the Bill means that it will be a case of come one, come all, and a loose arrangement.
According to the principles, there must be an emphasis on outputs in the arrangements. They must be timely, relevant and authoritative, and they must improve patient-client care. That is a very important area for professionals to be involved with. There must be clarity about who is to be involved and what is expected of them. There will be an agenda for professionals to follow. The system will not be haphazard.
There must also be a strong personal commitment to the intended outcomes by those involved. The professionals involved must accept the need for their input to be firmly based on research evidence where that is appropriate. Any old point of view will not do. There will have to be the clearest indication that soundly based evidence is brought to bear.
There is an underlying principle that those involved must be given access to all relevant available information, including any relevant research-based evidence which may be needed to underpin discussions. It will not be a case of the uninformed talking to the well-informed. There must be a proper sharing of information with professionals. I am sure that the House will welcome that.
I now come to the real change between those arrangements and the uni-professional activities that were undertaken before. There must be multi-professional, multi-disciplinary teamwork which addresses both the primary and secondary care aspects of any issue.
That part of the guidance is the nub of what is intended. Teams must be brought together for specific purposes and they must look across the board at the implications of what they are discussing. There must be good communication between those working on an issue and any other related work by the health authority.
That covers a broad spectrum of what the professionals should consider. It is right to set those points out in guidance and guidelines instead of being entirely prescriptive. It would be wrong to do anything other from the centre than lay out the principles. We do not want to place the health authorities in a straitjacket. We must address the important principles that will underlie the vital matter of consulting professionals.
I hope that I have gone some way towards convincing Opposition Members that, although the guidelines are not as prescriptive as former arrangements, the principles are very firmly in place and I am sure that they will be broadly welcomed on both sides of the House.

Mr. Gunnell: The seven principles are set out in the document relating to the involvement of the professionals. That document is out for consultation. The principles


appear to be sensible, but there will presumably be a response to those principles and thoughts about how one involves the 17 different professional groups identified.

Mr. Malone: That is right. The principles are not set in concrete. As I said in Committee, and I repeat it tonight, we are talking about draft guidelines. However, the general thrust of the guidelines is clear. While there may be some modification around them, they are very important principles to which we will adhere. There is no suggestion that, as a result of consultation, we will suddenly say, "All these principles should simply be scrapped and we will set this out on a half-page of A4." That is not the Government's intention.
I was keen to come to the House on Report to honour the commitment that, whatever guidelines are agreed after consultation, they will be give statutory force in the sense of the general obligation to take professional advice. It was right to do that at this stage.
The hon. Member for Stockport (Ms Coffey) said that the amendment should be extended to take account of user groups. I said in an intervention that the interests of user groups are partly catered for by CHCs which do extremely important work. I again confirm to the House, as I explained in Committee, that that work will continue under the new arrangements.
However, that is not all that happens when we take account of the views of consumers and carers. The hon. Member for Stockport specifically and rightly referred to that point. I remind her that the national users and carers monitoring group advises the Department, particularly with regard to the implementation of community care. The Department listens to that very important group, and the interests in that area to which the hon. Lady specifically referred are brought directly to the Department's attention.

Ms Coffey: I understand that, but surely the Minister is aware that the problem is that there are no national criteria for the delivery of community care locally. There is an enormous variation in terms of criteria in respect of who is going to be accepted for care by a health authority and who is going to be paid for by a social services department. Although a national monitoring group is welcome, it does not address the problem of the local issue and the particular local criteria.

Mr. Malone: As the hon Lady might anticipate, the purpose of informing nationally is not so that that can be done, everyone goes home and nothing happens. What happens on the ground is influenced in the new structure set out in the Bill. That will involve the regional officers who will ensure that best advice is given through health authorities and so on. There is a flow down from such national advice and, as I said in Committee, guidelines to be published in due course will clarify a number of matters to which the hon. Lady referred.
In conclusion, I am delighted to be able to bring the amendment to the House on Report. There has been much discussion outside the House about increasing the weight of professional involvement from a range of people whose advice perhaps was previously honoured more in the breach than in the observance. A combination of the statutory power with the guidelines which we will issue once the consultation has been concluded will put that

right, and will assure all those who are concerned with the best possible delivery of health care and with the performance of health authorities that their voice will be heard, and heard effectively. I commend the amendment to the House.

Amendment agreed to.

Schedule 1

AMENDMENTS

Mr. Morgan: I beg to move amendment No. 5, in page 6, line 27, at end insert—
'(2) The Secretary of State shall be under a duty to give directions to such Health Authorities as may be established in Wales, requiring them to act so as to secure—
(a) the promotion of common standards in the purchasing of equipment for, and design of capital works by, those authorities,
(b) the publication from time to time of such information, including annual performance targets and details of defective or deficient work by contractors, as is necessary to enable progress towards the achievement of such common standards to be evaluated, and
(c) the organisation of clinical and non-clinical services on an all-Wales basis where that represents the most efficient and cost-effective means of providing such services.'.
I am pleased to be able to speak to an amendment that deals specifically with some of the problems pertaining to the application of the Bill in Wales. When one thinks of past major political figures from Wales such as Lloyd George and Aneurin Bevan and the contributions which they made to the development of the NHS, it is right that we should have a debate on Wales. No doubt The Sunday Times will run a story next week alleging that Lloyd George and Aneurin Bevan were Soviet agents with the code names of "Snow White" and "Taffy", or some such invention in which it specialises.
There are areas where we are somewhat dissatisfied with the application of the Bill to Wales. The Bill should probably have solved more problems than it does. It comes forward with a raft of measures which try to bridge the long-standing gap between the purchasing of secondary and primary health care. It tries to reflect in statute the equalisation of status between GPs and the primary health care which they represent on the one hand, and the consultants and hospitals on the other—the historic prima donna-shopkeeper split within the medical profession—by merging the health authorities and the family health service authorities. That is okay as far as it goes.
The Bill gives power to the Secretary of State to come back later and to merge those authorities geographically as well, and that is also okay as far as it goes. It would have been better to have some way of debating that now. The amendment attempts to tie down the duties of the Secretary of State further, because there is a plain failure in the way in which the Bill has been drafted, to cover a lot of things which would have been covered had this been proper, competent and timely legislation.
There should have been coverage of a unified complaints authority, and we try to deal with some aspects of that in the amendment. There should have been some reference to the future of the two special health authorities in Wales. Either merging them or doing whatever it is that the Secretary of State intends to do would at least mean


that we could debate the authorities. We have also covered that issue in the amendment in the best way we can to ensure that there is some form of debate on the issue.
Finally, we need to clarify the role of the newly merged health authorities in relation to GP fundholders and other providers, hospital providers and the Welsh Office. It is an eternal triangle between the Department allocating the budget, the GP fundholders and health authorities as purchasers and finally the provider units such as trusts or directly managed hospital and community health care units. Those involved in that eternal triangle—in which the Secretary of State is the hypotenuse—must work out their relationship in an entirely new ball game.
We have attempted to clarify that matter by giving the Secretary of State a set of duties. The Bill gives the Secretary of State all of the fun, and none of the duties. The fun is that he can decide without much debate after the Bill has reached the statute book how many health authorities there will be in Wales and what their function should be. Of course, he can announce the annual allocation of the budget, but he will not have any duties. We have injected duties into the amendment, so that the Secretary of State can impose duties on the purchasers and providers in the new health care system.
The Bill, as has been often emphasised by Ministers, is a part of the final piece in the jigsaw of the health care reforms of 1990 and the establishment of trusts and GP fundholders. The effect of all that has been to break up the NHS in Wales into some 200 small businesses, which can buy their own equipment and services and manage their cash flow and capital expenditure, and which are able to save money by more astute purchasing. We have to decide—as taxpayers—what leeway those units will have to deal with that money.
The Secretary of State must decide how much leeway he wants those 200 small businesses to have in how they spend their money, particularly when they can squeeze some cost savings out of the providers of health care and not spend all of the money that they been given through their capping formula. It is a difficult area for hon. Members. We are responsible to the taxpayers for the way in which the money has been raised, but we must assure taxpayers back in our constituencies that we are sure what has happened to their money.
The breaking up of the NHS in Wales has led to the creation of 200 small businesses. If we apply that across Britain, we would be talking about several thousand small businesses. We cannot be sure what is happening to all of the money, and that is why we are trying to establish a set of duties for the Secretary of State to try to co-ordinate a system after the Government have broken the NHS into pieces.
I shall give a simple example of the duties which we want to establish. The Welsh Office has produced documents relating to the general practitioner fundholders steering committee—there is an oxymoron if ever I heard one. The whole purpose of fundholding is to break up the system and allow GPs to do their best to buy health care with their own money; but, as soon as they set up as fundholders, they almost immediately form a steering committee to bring them back together again and to tell them what they ought to be doing.
From the documents it is obvious that, in the coming financial year, GP fundholders are expected to make savings of some £10 million, and that will be free money for them. If we gross that up for the whole of Great

Britain, we are talking about £200 million of free money for GP fundholders to spend in ways which we cannot account for. That is why fundholders buying equipment should do so under a direction from the Secretary of State.
If GP fundholders next year—when they will only be responsible for some 40 per cent. of the patients in Wales—have £10 million to spare, they will have made what is known as efficiency savings, although I do not think the word "efficiency" is used. That is free money, available to GPs to spend as they wish on capital equipment. They can extend their surgeries or buy additional physiotherapy or chiropody equipment. We have no way of registering the equipment, or of telling them that some forms of capital expenditure may benefit their pensions. When a GP retires at 65 or 70 and sells out his share of a practice, his pension may be enhanced by taxpayers' money.
We need control over the process by which money which we have approved as taxpayers becomes eligible for savings simply by prescribing cheaper drugs or by forcing a harder bargain out of providers. We all want them to try to do that, but not necessarily in such a way that benefits their pension when they, as GPs and self-employed contractors to the health service, retire and sell out to a younger partner. If the practice has been extended three or four times, it will be worth a lot more when the GP sells up at 65 than it would have been if the taxpayer had not enabled him to have the ability to spend on capital equipment.
The fact that the matter has perplexed the Government is shown in the general practitioners steering group documents. The matter is obviously causing the Government considerable problems in terms of the accountability of GP fundholders for the money that they draw out of the system by extracting "savings". Strangely, non-fundholders make the same savings but do not have the right to spend the money as they want on improved services. That money still belongs to the family health services authorities and is part of the traditional allocation from taxpayers' money. If it is not spent, it returns to the Treasury; if it is spent, the same amount plus an allowance for inflation is allocated the following year.
The difference in treatment of fundholders and non-fundholders is not logical as there is no evidence that GP fundholders gain more in efficiency than GP non-fundholders. But they are given the benefit of spending taxpayers' money as though it were their own. I admit that they must spend it on patient care but it can be spent in a way that makes a considerable capital gain throughout a GP's career.
Given that, next year, "free money" will amount to £10 million in Wales and £200 million in Great Britain, we must know what the Minister has to say about it, particularly in the light of all the questions that have been asked in the general practitioners steering group, which was set up by the Welsh Office to try to restore order to the chaos that it created. It is totally bewildering that the Government never foresaw that problem when they proudly set up the GP fundholders scheme in 1990 and announced the creation of those wild cards, which would float freely and be able to negotiate their own bargains.
The amendment also seeks to provide that, as well as enabling powers that determine how many authorities we need, health authorities should have annual performance targets for themselves and suppliers of equipment, buildings or whatever. That links with the point about the


need for health professionals to be involved, through local medical committees, in advising on the purchase of X-ray equipment, sterilisers and various aspects of the health services' purchasing functions. There should be a professional input, and we hope that annual performance targets will help.
In that process, a function exists for at least one all-Wales special health authority. We have tried to frame the amendment to fit in with the enabling pattern of the Bill. Sub-section (c) implies that, ultimately, the Secretary of State has discretion in that matter. It would be nice to have the whole Bill before us so that we could see the detail of all the practical implications. The enabling style of legislation that is becoming increasingly common makes debate at this stage far more difficult than in the past.
The amendment seeks to oblige the Secretary of State to set out clearly for those in the health service what the performance of an all-Wales health authority should be. There are two such authorities at the moment, but we do not say whether there should be one or two. We say that, where the benefit of having an all-Wales health authority is evident, the Secretary of State should not be held back by a dogmatic aversion to an all-Wales health authority such as we have now. At present, dogma seems to drive the exercise.
At the last Welsh Grand Committee but one in June last year, the Secretary of State told the Committee that he did not like the structure of the Welsh Health Common Services Authority, which has clinical and non-clinical aspects. At that time, 1,000 people worked in the non-clinical part at the new headquarters building at Cardiff bay. The Secretary of State said that he would market test the non-clinical part of that outfit.
Market testing is Government policy, and the Government do not require the House's authority to carry it out. But having announced that he would market-test the authority, the Secretary of State engaged not in market testing but in his own version of market testing—a game of "heads I win, tails you lose". The aspects of the authority which he wants offered up to the private sector are not allowed to compete against the private sector. People in those jobs have been told that it is not market testing in the usual sense. It is a new phoney version of market testing in which they are not allowed to make an in-house bid.
The staff are extremely upset about that, because they were led to believe that the authority would be market-tested. A subsequent ministerial instruction appears to have been given to the Welsh Health Common Services Authority that there can be no in-house bids. That has not happened with the authority of this House. We have not come across that framework or any legislative backing for a "market testing exercise"—those are not my words but the words of the Secretary of State in the Welsh Grand Committee last year when that policy was announced—but it has subsequently been introduced by the actions of the Secretary of State, who says that his version of market testing involves no in-house bids.
7.45 pm
The staff are wondering what they should do. Should they simply resign and just give up? They have suggested that, if they cannot engage in a classic in-house bid, as

would normally be the case in market testing, they could try to privatise themselves so that they could bid for their jobs against outside contractors. But they have been told that they can have no assistance for doing that.
Normally, the civil service and public agencies are allowed to employ accountants and legal advisers, but in this case they are being denied assistance and have been told that it will be strictly private contractors bidding for their jobs. That could result in no more than 100 people working at the Welsh Health Common Services Authority in 18 months' time. Indeed, I am told that that is the Government's estimate.
Another oddity that I should draw to the attention of the House, as it is relevant to subsection (c), is that among the people who have inquired about bidding for a large part of the Welsh Health Common Services Authority is W.S. Atkins and Partners, a company that is on a cautionary list published by the Department. The Welsh Office has told the authority that, except in exception circumstances for small jobs, it cannot use the company for hospital design work because it is responsible for the two major hospital design disasters of the modern Welsh health service, in Gwynedd and, before that, at the University Hospital of Wales, and it was required to make out-of-court settlements to the Welsh Health Common Services Authority with respect to those design disasters. Although it is on a cautionary list, sent on the Department's instructions to the authority, it is allowed to make an inquiry into buying the whole service and could take over hospital design services. That is the height of absurdity.
As we said earlier, we need a clear list of the minimum standards required within the health service. Contractors are used by health authorities throughout Wales, and they must abide by a minimum standard set by the Department. Nowhere is the need for standards more clearly illustrated than by the appalling case of the stillborn baby who was transported from Wrexham Maelor hospital to the University Hospital of Wales in Cardiff for pathological examination. It took sixteen and a half hours to travel by private courier from Wrexham to Cardiff. The firm did not say how long it would take to reach Cardiff or whether it would go direct, and the package containing the stillborn baby appeared to have been left outside in the rain. That is why the package partly broke open when it arrived in Cardiff.
How can it take 16 and a half hours for a package of that sensitivity to travel a journey that most of us know takes only four hours these days? That courier firm should not be on any private contractor list for any health trust, hospital or health authority anywhere in Wales. We need common standards and we need a clear complaints and public inquiry procedure to ensure that those matters are brought out into the open and not squashed.

Dr. John Marek: My hon. Friend referred to the incident concerning the stillborn baby in Wrexham. The health authority produced a good report, in which it admitted that it was at fault, but of course it did not explain the length of time that it took for the baby to reach Cardiff, how it went and the instructions that were given to the private courier firm. However, the health authority has said that it will not use private courier firms in future, which is a good thing.
I asked the Welsh Office whether it would issue guidelines and at the time it said that it would not. Will the Minister reconsider that? If there is a case for issuing guidelines to hospitals in Wales, that surely must be it, and it is also a recommendation for amendment No. 5.

Mr. Morgan: I am grateful to my hon. Friend the Member for Wrexham (Dr. Marek) for using that argument, as the hospital is in his constituency and he has drawn attention to the need to set minimum guidelines. When one has an awful story of that type—

Mr. Richards: I wish to clear up that matter, as it obviously was a ghastly incident, which I am sure everyone in the House regrets. The trust has prepared a report about that unfortunate incident. That report is with my Department and we are examining it carefully. If anything can or should he done or needs to be done, obviously we will do it. I do not think that we want to go much further on that point.

Mr. Morgan: Obviously, something must be done; but it is not adequate for the Minister to say that he is considering it in the Department to discover whether anything needs to be done. Obviously something must be done; it is merely a matter of trying to decide exactly what it is.
From the point of view of amendment No. 5, it is obvious that it is now up to the Welsh Office to set minimum standards and not simply to leave the setting of standards to each hospital. As my hon. Friend the Member for Wrexham said, the Wrexham Maelor trust itself prepared a report. It was an internal report, but it has been placed in the Library of the House and we have been able to read it. It is evident that the report tends to skip the critical facts—the exact way in which the package got rained on and the exact way in which a package of that sensitivity could possibly be transported to Cardiff in such a way that it took sixteen and a half hours to do a four-hour journey.

Mr. Allan Rogers: I accept that the issue is extremely important, but I caution my hon. Friend not to labour the Welsh Office with tackling issues that would perhaps best be tackled at trust level. As long as the trusts exist, I should have thought that we should say to them, "Carry out your job properly."
I would hate to think that in future the Welsh Office, which has great difficulties in coping with its job at present, a fact of which we are manifestly aware, will start laying down standards for everything. That is one of the big problems that we should consider as regards the distribution of effort throughout Wales and the level at which it is carried out.

Mr. Morgan: That is the most backhanded compliment to the Welsh Office that I have heard in my time.
We have mentioned the question of the way that one provides a form of health service in Wales in which we try to give people incentives to improve their efficiency but not necessarily resulting in those people doing much better out of it financially than before. The Government have converted people into quasi small businesses in a quasi-market. We are not happy with that.
I think that some sort of warning system is being given to me, but I am not quite sure how it has been worked out. A new form of mathematics is being used in the timing mechanism here.
The contrast could not be wider than on the issue of the blood transfusion service in Wales—an all-Wales service, which is run by the Welsh Health Common Services Authority. Uncertainty remains as to what will happen to it. The Secretary of State has said that, for the time being, it will remain under the care of the Welsh Health Common Services Authority, but when we are engaged in the process of primary legislation of that type, we do not want references to what the Secretary of State will do for the time being; we want to know what the Secretary of State will do.
The donor donates free of charge to the blood transfusion service. The costs that arise are simply the on-costs of the blood transfusion service itself, which governs what happens when the blood is passed on and processed or otherwise for use in operations. However, it is a free service. That is in total contrast with the increasing business and quasi market climate that the Government have created—a broken-up health service with everyone acting as their own business managers in a way that contrasts starkly with the ideas that Lloyd George and Aneurin Bevan originally had when they made a great contribution to the social system of the country by setting up the national health service.
That is why people in Wales feel especially strongly that the health service should remain a unified national health service, and that is why we have tabled the amendment. I commend it to the House.

Mr. Richards: First, I should like to reply to one or two of the arguments of the hon. Member for Cardiff, West (Mr. Morgan). The Bill does not deal with special health authorities, as those are established by order and are not affected by the measure that we are discussing.

Mr. Ted Rowlands: Will the hon. Gentleman give way?

Mr. Richards: If I must.

Mr. Rowlands: As we are in Committee, would it not be a better idea for the Minister to listen to the debate first and listen to an expansion of the case by my hon. Friend the Member for Cardiff, West (Mr. Morgan) before trying to reply to it?

Mr. Richards: No; we are on Report. If I feel that I need to speak after the hon. Member for Cardiff, West makes a unique contribution to the Bill, I shall decide to do so at that time if it is appropriate.
Fresh powers are not needed to deal with the special health authorities, the Welsh Health Common Services Authority or the Health Promotion Authority for Wales. Indeed, I am fascinated that the hon. Member for Cardiff, West, who has a distaste for quangos, should wish to create what would, in effect, be a super health quango for Wales. It is not in keeping with his general distaste for health authorities.

Mr. Morgan: Can the Minister confirm that it would result in the saving of one quango, with all the board expenses that that involves?

Mr. Richards: It would not at all result in the saving of one quango. It would create a quango at least three times as large as the quango that we have already.
The proposals on the relationship between health authorities and GP fundholders will be worked up in the next few months in consultations among those involved.


That work will consider accountability issues in detail, and the general practitioners steering group, to which the hon. Member for Cardiff, West referred, is part of that process.
The amendment is unnecessary to achieve the efficient and effective delivery of services. In the case of capital works, it would, in any event, not secure what the hon. Member for Cardiff, West seeks, as it does not acknowledge that the Welsh Health Common Services Authority, which is a special health authority, and NHS trusts have the key roles in contracts on capital works. In the case of capital works, it would add to the activities of health authorities and create a further tier of responsibilities, with additional bureaucratic costs cutting across the functions of NHS trusts. The design and implementation of capital works are subject to the law governing contracts between the NHS organisation concerned and the firm carrying out the work.
Standards for the design of health buildings are published by NHS Estates and the Welsh Office and are common to England and Wales. Those include health building notes, health technical memoranda and health facility notes, which are used by designers, whether in the public or the private sector.

Mr. Rogers: With the health trusts themselves being responsible for the placing of contracts for capital works, is the Minister now saying that they are bound to stick to the designs and specifications as laid down in the standards that he has just said are appropriate for Wales and England?

Mr. Richards: The hon. Gentleman clearly did not listen to my first sentence. Standards are published by NHS Estates and the Welsh Office and are common to England and Wales. They include health building notes, health technical memoranda and health facility notes.

Mr. Rogers: Will the Minister give way?

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Mr. Richards: No, I will not give way to the hon. Gentleman; I think that I have made that point perfectly clear.
The documents are all available through Her Majesty's Stationery Office. If the hon. Gentleman wishes to study them, he is welcome to do so. Each development is project managed carefully. An evaluation is required for all capital projects which should identify important lessons in the planning, design, cost control and procurement of schemes, as well as in the use of the facilities.
The private sector undertook 30 per cent. of the contracts placed for design over the past five years. The vast majority comply with all conditions and, where performance of contractors is considered unsatisfactory, any failures are pursued in line with the contract in the first instance; that would include action to remedy defective or deficient work by contractors.
The Welsh Office is made aware of the conclusions of evaluations of all projects. That will continue whatever the outcome of the review of the EstateCare Group within

the Welsh Health Common Services Authority. What the amendment seeks to achieve is already undertaken and, therefore, it is unnecessary.

Mr. Morgan: I think that the Minister has covered only hospital works. The departmental GP fundholders steering group refers in its document to the savings that GP fundholders can make. In paragraph 16, it says:
Savings must be used for the benefit of the patients of the practice. This statutory requirement allows the purchase of equipment and improvement of practice premises.
The question of what happens to the "free money" that GP fundholders have—it was £4.7 million in the last financial year, it is about £7 million this year and it will be about £10 million next year, and it can be spent on premises—applies also but, unfortunately, it is not covered by what the Minister has said.

Mr. Richards: I am astonished that the hon. Gentleman should speak in that way about savings that can be, and are, made by GP fundholders. He has said that any savings made—considerable savings can be made—should be used for the benefit of patients. Surely the hon. Gentleman welcomes any development whereby more resources are made available to patients. I know how the hon. Gentleman will reply; but before he says that premises should or should not be included, I remind him that even the development of premises can be beneficial to patients—particularly if it means that consultants can visit GP fundholding practices to consult patients.

Mr. Morgan: I am grateful to the Minister for giving way again. The amendment covers the way in which general practitioners extend their practices with the "free money". Unfortunately, there is nothing to oblige them to use the "free money". The departmental GP fundholders steering group document says:
Holding large cash balances is seen by some as an unproductive use of resources".
They are the words of the Welsh Office. The document continues:
Is this the case and, if so, is there a risk that if this continues it will lead to criticism because it denies patients treatment?
They are not my words; they are the words of the GP fundholders steering group.

Mr. Richards: With respect to the hon. Gentleman—I do not intend to pursue the point any further with him—I believe that that was a rhetorical question within the steering group document; it was not a statement.
The Welsh Office is currently consulting on proposals for the future management of three clinical services—the blood transfusion service, the artificial limb and appliance service and Breast Test Wales—currently managed by the Welsh Health Common Services Authority. The consultation document makes it clear that the proposals are aimed at ensuring that the services develop in response to patients' needs, and that improvements in efficiency are reinvested in patient care.
They also indicate that long-term programmes such as Breast Test Wales's contribution to the UK evaluation programme of screening as a means of treating cancer will be fully protected and that Wales will continue to co-operate with sister organisations elsewhere in the UK, for example, the blood transfusion service with the National Blood Authority. Assurances have been given about the continuing all-Wales requirements of the artificial limb and appliance service.
No final decisions have been taken on the proposals or the detailed issues which are out for consultation. We will take final decisions in the light of comments received. A reasonable period has been allowed for consultation and comments have been invited by 23 February. I reject the suggestion from some quarters that, because it took some months to work up proposals, a similar amount of time must be spent on consultation.
I do not wish to anticipate decisions on the three clinical services delivered by the common services authority. Clearly there is merit in placing them in NHS organisations with relevant clinical expertise, although we do not propose any change in the current arrangement for the blood transfusion service for the time being. As the House is aware, their location within the common services authority is for management purposes only.
Finally, it might be helpful if I set out the approach to the provision of clinical and non-clinical services generally. In the case of clinical services, decisions will be taken with a view to securing the most efficient and cost-effective results. Health authorities will commission services on that basis, and where it is appropriate for more than one to purchase together for a particular service, they will do so. With only five authorities in place from April 1996, subject to the passing of the Bill it will be possible for them to establish an all-Wales consortia to do so if that is appropriate.
I am glad to say that progress is being made on the work which has been under way within the common services authority to bring about market testing and the possible privatisation of non-clinical services. I wish to bring matters to a conclusion, and I am grateful for the support of the hon. Member for Cardiff, West, so that NHS trusts have the opportunity to purchase support services—information technology, supplies, estate design and maintenance—in the most cost-effective manner.
The establishment of NHS trusts means that decisions should be taken at the hospital level. Where it can be shown that there is an essential need to deliver services on an all-Wales basis, one option would be for authorities and trusts to create consortia. The common services authority accumulated a number of services before trusts were established and, therefore, there is no criticism intended of the staff concerned. We are now placing responsibility on trusts to obtain their services in a cost-effective manner.
Options for handling IT, supplies, estates design and maintenance will be ready for consideration in the next two months or so and, following that, tenders will be invited, as appropriate, for elements of activity. Until those exercises are completed, I cannot speculate on the outcome. However, I can assure the House that the whole exercise will be completed in the next financial year. The common services authority has already told its staff that my right hon. Friend wishes to have a small organisation in place by April 1997.
The hon. Gentleman was quite wrong when he said that my Department had sent instructions to the common services authority to say that in-house bids would not be entertained. That is quite untrue: in-house bids will be allowed. I must stress that the April 1997 date has been set to allow for all detailed implementation arrangements to be carried through.

Mr. Morgan: Will the Minister clarify what kind of in-house hid he means? I illustrated two kinds in my

remarks. Is he referring to the conventional kind of market-testing approach, whereby an in-house bid from within the civil service or a public agency is allowed; or does he mean a situation where the in-house team is allowed to buy itself out in a management-employee buy-out? If that is so, why has it not been given the legal and accountancy assistance which is normal in those circumstances to permit it to make a viable in-house bid outside involving the same people?

Mr. Richards: I was responding to the hon. Gentleman's comments because he asserted that the people already working within the common services authority would be excluded from making any form of bid. Without prescribing one form or another, they will not be excluded in the way that the hon. Gentleman implied.
There may be a need to consider with health authorities and NHS trusts how consortia can be established to run some of the services now located within the common services authority, and I would not wish at this stage to give an indication of the ultimate size of that organisation.
I share many of the points made by the hon. Gentleman. In particular, I was delighted that at the start of his remarks he welcomed the principle of the Bill of merging the district health authorities and the family health services authorities in Wales. There is agreement between us that delivering services in an efficient and cost-effective way is of paramount importance. I have outlined how we intend to achieve that for the reasons I stated. It is not necessary, however, to include such provision in the Bill, and I urge the House to reject the amendment.

Mr. Rogers: I shall be brief. The Minister ended his speech on a note of critical importance to any part of the reorganisation that is to take place, with his reference to efficiency and cost-effectiveness. The Opposition accept that that is necessary, but quality standards and clinical effectiveness are also necessary in a national health service. A drive simply for efficiency and cost-effectiveness by a group of accountants, politicians or bureaucrats is losing sight of what the national health service is all about. Quality standards and clinical effectiveness are equally important. I am glad to see that the Secretary of State has arrived to hear my pearls of wisdom this evening. [Interruption.] As my hon. Friend the Member for Bridgend (Mr. Griffiths) says, she came back especially to listen to me.
I have a little problem with the amendment moved by my hon. Friend the Member for Cardiff, West, in that I am always concerned about over-centralisation. As I said earlier, the Welsh Office has great difficulty in coping with its functions and on occasions it appears to be breaking down. I hesitate to transfer willy-nilly all sorts of functions to the Welsh Office.
If there is to be a centrally imposed direction on the trusts, whether it be at health authority level or from the Welsh Office, it ought to be consistent, coherent and agreed generally with those who have to provide the services to the patients. The measure is not about good order in the Welsh Office, in health authorities or in the management of trusts, but about delivering services to patients.
Lastly, in addition to being consistent, coherent and generally agreed, decisions must be made swiftly. One of the problems that practitioners face now, particularly in


relation to standards being set across the board, is that the time taken to set those standards and implement them is quite inordinate.
There is no doubt at all that all-Wales services are appropriate—for instance, in genetics and national screening programmes. Breast Test Wales is a classic example of where it is necessary to carry out comparative epidemiological examinations of the facilities that are provided. Of course we have a special point—as I am sure the hon. Member for Ynys Môn (Mr. Jones) is aware—in carrying out certain clinical facilities, but north Wales is often far better served from Mersey, the north-west and the west midlands.
I would hate us to continue talking about all-Wales provision of services on a nationalistic basis when services would be better provided from across the border in a much more efficient and coherent way. Perhaps the hon. Member for Ynys Môn has a different perspective on the delivery of national services as such, but I am quite sure that the patients in north Wales, who are more crucial than any artificial boundaries, would appreciate the maintenance of the high-quality service often given by hospitals in Liverpool and Manchester to north-east Wales.
My hon. Friend was right to have tabled the amendment because there is enormous concern among health service providers in Wales about the size of the common services authority. I was pleased to hear the Minister saying that he was seeking to make sophisticated or to streamline the functions of that organisation. We have witnessed central management costs spiralling upwards, while at the same time there has been much pressure on reducing management costs in the NHS in Wales.
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I have been given to understand that there has been little consultation with NHS Wales on the future of the common services authority, but I take hope from what the Minister has said. If he carries out what he has promised, I am sure that some of the present fears will be overcome.
I said a little earlier that the problem of long time scales—for instance, in respect of the design of capital works by the CSA—could be resolved if there were proper dispersion of work to the appropriate level. There is evidence that the private sector could reduce those time scales without necessarily reducing the quality or the standard of the work, but I am concerned that certain standards are set.
I tried to intervene during the Minister's speech when he spoke about the standards that are evidently relevant for England and Wales in respect of designs and specifications. If he made those standards mandatory on trusts, as they will be drawing up the designs and contracting out capital works, that is the best level at which to implement them; on the other hand, if a trust feels that it can aim for a lower standard and lower specifications simply to save money, we shall again reduce the service to patients.

Mr. Gareth Wardell: I can think of no better example of his point than the siting of the Prince Phillip hospital in Llanelli, which was built on the site of two

former coal shafts. As a consequence, it cost the trust and/or the Welsh Office some £800,000 to ensure that the site was safe before the hospital could be built.

Mr. Rogers: As an engineer and geologist by profession, when I had a proper job, I fully appreciate the problems that the designer might have had. I am still waiting for the Dungeness power station to fall down.
My hon. Friend is absolutely right. Unless standards are given and specifications followed, once they are diluted or are brought down to the level of health trusts, the in-house design capability will be inadequate to ensure that problems such as the incident that my hon. Friend has outlined do not take place.

Mr. Wardell: Does my hon. Friend agree that, because the Government have taken some rather stupid decisions—such as the transfer of all the coal records from south Wales to Bretby—when hospital trusts or any other trusts wish to establish new buildings, the cost of finding those records and seeing what they say adds enormously to the costs and poses difficulties, not only to the health service in Wales but, indeed, to everyone else?

Mr. Rogers: I entirely agree. That is why I hesitate to support the offloading of functions to the Welsh Office. The present Minister, of course, is faultless; but before he entered his post, some very dubious decisions were made.
We may talk of cost, efficiency, effectiveness, structures and the specification of contracts, but ultimately those who use the national health service will be affected by our decisions. We have a duty to deliver the best possible service. If that can be done better at Welsh Office level, fine, but it would be better still for it to be done at trust level. I have serious doubts about the advisability of establishing too many decision makers: one may end up simply passing the buck to the others.
I shall support the amendment, but I consider it deficient in some respects. It refers, for instance, to
a duty to give directions to such Health Authorities as may be established".
Will those health authorities have common standards, or will they decide individually on different standards, thus creating a patchwork quilt of provision in Wales?

Mr. Morgan: Both.

Mr. Rogers: If that is so, and order will be maintained, I shall be quite happy; but if direction is to be centrally imposed, it must be consistent, coherent and generally agreed, and decisions must be made swiftly.

Mr. Ieuan Wyn Jones (Ynys Môn): I am pleased to be able to speak in a debate that gives us a rare opportunity to consider some aspects of the health service in Wales. I am grateful to the hon. Member for Cardiff, West (Mr. Morgan) for drawing our attention to a number of important issues.
I am also grateful to the hon. Member for Rhondda (Mr. Rogers) for giving me an opportunity to respond to some of the points that he made. He seemed to suggest that I would not welcome cross-border co-operation; it may come as a nice surprise to him that I have always welcomed the fact that many of my constituents—and, indeed, members of my family—have benefited from the specialty services that exist in Merseyside—at the Clatterbridge centre, the Christie hospital and elsewhere. Long may that continue.
The hon. Gentleman may also be interested to learn that my wife received an excellent training at the royal infirmary in Liverpool. I have no problem with the idea of cross-border movements, in terms of either specialties or staff. Let me go a little further than the hon. Member for Rhondda, and suggest that we need to adopt a strategic approach to both clinical and non-clinical health matters in Wales.
The decision of the Welsh Office to market-test the Welsh Health Common Services Authority has caused great problems in Gwynedd. In preparation for the market-testing exercise, the authority decided to provide the Welsh Office with some examples of ways in which it could cut costs. It suggested, for instance, that the stores provision at Ysbyty Gwynedd should be closed, and that medical and other supplies should be provided from a store in Denbigh in the Vale of Clwyd. I have no problems with that; I know the area well, having lived there for many years, and my wife's family originated there.

Mr. Morgan: Before she went to Liverpool.

Mr. Jones: And since she went to Liverpool. I hope that the hon. Gentleman realises that I support his amendment. If he wants me to attack it, however, he is going the right way about it—particularly if he says some nasty things about my better half.
If medical and other supplies are transferred from Ysbyty Gwynedd in Bangor to Denbigh, it will not be possible to provide the same standard of service or to do so more efficiently. When Ysbyty Gwynedd was built in 1970, the stores were built alongside it. That meant that the wards were built without sufficient capacity to take on-site medical supplies. If the move takes place, there will not be enough space in the wards at Ysbyty Gwynedd to maintain sufficient supplies from time to time. Supplies will have to be transferred from the Vale of Clwyd by road, which will mean increased road traffic and increased costs.
That is the sort of decision that the Welsh Health Common Services Authority has already made, in an attempt to demonstrate to the Welsh Office that it can save money. But what will be the cost to the people of Gwynedd, who need a health service that is properly resourced and has sufficient capacity within the county to deliver medical and other supplies?
During the summer months in particular, it may be difficult for supplies to be brought quickly from the Vale of Clwyd to Bangor and other Gwynedd hospitals at times of emergency. We disapprove of the kind of decisions that are now being made, but if the amendment were accepted we could deal with the position, because the Welsh Office would have to give the authority guidelines on how it should discharge its responsibilities.
It is, after all, the responsibility of Government to ensure that medical and other supplies are available to hospitals when they need them. What will happen under market testing? If a private firm says that it will provide the services that the common health services authority currently operates, what comeback will there be if it proves unable to deliver those services?
The Minister said that the Government were currently considering only market testing of non-clinical supplies, and I accept that; but this is a first step towards further developments. Despite what some hon. Members have said, I will support the amendment, and urge the

Government to do the same. From time to time, strategic decisions will have to be made that can be taken only at an all-Wales level.

Mr. Nick Ainger: The possibility of establishing fewer health authorities in Wales is one of the main aspects of the amendment. My constituency contains what is probably the smallest health authority currently operating in Wales—if not in England and Wales—and I am extremely concerned about the impact that the Bill may have not only on my constituency but on those of my hon. Friend the Member for Carmarthen (Mr. Williams), my right hon. Friend the Member for Llanelli (Mr. Davies) and the hon. Member for Ceredigion and Pembroke, North (Mr. Dafis).
This year's announcement of funds for the Pembrokeshire health authority was linked with the announcement relating to East Dyfed. In effect, a Dyfed health authority has already been created. But the indications are that Dyfed and Powys—the old, soon to be the former counties—will be united in a huge health authority, which would cover more than 50 per cent. of the service in Wales. Hon. Members who do not know Wales may find it interesting that it would be far quicker for me to travel from the extremity of my constituency to this place, than to travel from one extremity of the proposed health authority to the other side. It would probably take me twice as long to get from the far west of Dyfed to the far east of Powys than to travel to this place.
The objection to the Bill involves the lack of accountability inherent in it. In relation to local government in Wales and England, the Government are saying that small is beautiful and that local authorities should be getting closer to their electorate and to the people they represent. Unitary authorities will be in place in Wales from April 1996. It is remarkable that, in relation to the provision of health care, the Welsh Office may be saying the complete opposite: that big is beautiful, and that being further away from patients and people who need care is a far better system. That is extremely worrying.
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Many hon. Members on both sides of the House objected to the possibility of a reduction in the number of police authorities in Wales because of the lack of accountability, and because of the extremely effective performance of the smaller, in particular, rural police authorities. I would be worried if, because of the Bill, the Secretary of State for Wales could create extremely large health authorities.

Mr. Gareth Wardell: Does my hon. Friend agree that, as the Government are proposing to reduce the number of health authorities in Wales from 17 to five, it is vital to realise that some hospital trusts in Wales are relatively small, and that it would be helpful if some of them were amalgamated? Their delivery of services could then be improved, and the sort of duplication that occurs in some of them would not arise.

Mr. Ainger: I agree. I welcome the amalgamation of district health authorities with family health services authorities. I am concerned, however, that combining those authorities will create large organisations, which will in effect, because of the enormous areas involved, become extremely remote and difficult to organise. That


is certainly the case with Dyfed-Powys, which I am concerned about. If the Secretary of State goes down the road of combining FHSAs with district health authorities, that will obviously cause administrative problems. Those two organisations have different roles.

Mr. Rogers: I am sure that my hon. Friend is right in some of what he is saying, but we should remember that we are seeking to amend the awful system that was created by a Tory Government in 1973. Before that, far more effective and closer delivery of health services took place. There were, for instance, hospital management committees, which were much more appropriate for some areas. The false structure set up by the Conservatives in 1973 has been so inefficient and so bad that it must be amended. It was amended once, and it is still being amended now. I still would not want large authorities to operate to the detriment of small units, with a personal delivery at hospital level.

Mr. Ainger: I agree. We must remember that the Bill is relevant only to health authorities—the purchasing authorities—and not to the running of hospitals. They must be sensitive to patient needs, because they are the ones that will be purchasing health care from the various trusts and from directly managed units. I do not want to be accused of making an awful pun, but they must obviously have their fingers on the pulse of what is required in their areas.
It is important to remember that it is only a couple of years since reorganisation. In Pembrokeshire, we saw the disastrous effects of that reorganisation, which followed the establishment of the Pembrokeshire NHS trust and of the purchaser-provider split.
In September 1993, Pembrokeshire NHS trust and Pembrokeshire health authority, prompted behind the scenes by the Welsh Office, called in independent advisers to sort out the problem where they could not agree a contract between themselves. They had to approach the chief executive of Clwyd health authority, Mr. Brian Jones, and the finance director of the Wrexham Maelor hospital trust, Mr. David Galley, to consider what had happened since the establishment of the trust and, effectively, the emasculation of the then Pembrokeshire health authority.
It was an interesting report. Those two men spent three months in Pembrokeshire considering in great detail what had happened immediately before and immediately after the establishment of the trust. Their report makes interesting reading. It is certainly worth quoting. This is what those two experts in health care had to say about that reorganisation:
the residents of Pembrokeshire did not receive any increase in the level of services provided, although increased levels of expenditure were taking place.
Pembrokeshire health authority lost virtually all its members of staff, bar two, to the new trust, because of the way in which purchasing staff had been transferred to the trust from the authority.
The report continues:
a minimum of £750,000 has been diverted from purchasing health care for the Pembrokeshire population into additional purchasing management costs.
The money went into administration, not health care.
We should not forget that the report was written by people who had spent virtually all of their working lives in the NHS and who were senior individuals. They went:
there appears to have been a significant increase in the cost of employing a number of senior managers within the trust during its first year of operation.
Basically, that related to one particular individual, the then chief executive of Pembrokeshire NHS trust. Before the establishment of the trust, he had been general manager of the Pembrokeshire health authority, where he had received a salary of approximately £50,000. At the end of the first year of the operation of the trust, that individual, as chief executive of the trust, received a salary of £73,000—an increase of £23,000 in 12 months. By the end of the second year of the operation of the trust, he was receiving not £73,000, but £87,000. That is why we need to be careful, to establish a properly accountable system of health delivery, and to be sure that we do not make a mess of further reorganisations.
That individual has retired from the Pembrokeshire NHS trust under interesting circumstances. I am told that the chairman of the NHS trust was informed by the chief executive in December 1993 that he had completed virtually 30 years in the NHS, and that he was looking for pastures new. He joined the NHS from school and, even after completing 30 years of service, he was only 47.

Mr. Rogers: My hon. Friend is being extremely unkind. He does not realise—I am sure that the Minister will advise him later—that executives of health trusts are in enormous demand within industry and management outside the health service, as well as in America and Europe. They need to have their salaries doubled year after year so that they can be retained in the health service. I am sure that the Minister will put my hon. Friend right.

Mr. Ainger: I am not being unkind. I understand that the individual is now running an antique shop. His successor, who in my opinion had greater experience of running large organisations at senior level, was employed on a new contract. His total emolument is not £87,000, but £64,000. That is a significant saving. In the meetings that I have had with Mr. Stuart Fletcher, the new chief executive of the Pembrokeshire NHS trust, I have been extremely impressed with the quality of his performance and experience.
It is interesting that Mr. Brian Davis told his chairman in December 1993 that he would like to leave the NHS trust to go to pastures new.

Madam Deputy Speaker (Dame Janet Fookes): Order. The hon. Gentleman is going into considerable detail. I hope that he can relate his comments more closely to the amendment under discussion. If not, it seems more like a general history.

Mr. Ainger: The essence is the lack of accountability within the current organisation in Wales. I am trying to enforce the point that we need an accountable system of administration in Wales in order to stop the abuse—I use that term advisedly—that has happened in the past.
We must never allow individual managers to assume certain powers, often because of the weakness and ineffectiveness of other members of the board who improperly control the way in which salaries escalate, allegedly under performance-related pay. It is worth referring to that, because the Jones Galley report said that, while that individual's salary was increasing in the two


years that he was chief executive, the performance was going down, and the £750,000 was spent on administration, not on health care.
It is vital that, if and when the new reorganisation takes place, it must maintain the true connection with our local communities, particularly in rural Wales. Large organisations find that difficult to do. It is important to ensure that, when we appoint new people to the boards, they know that they have a responsibility to ensure that the reorganisation is done smoothly, effectively and efficiently, and to ensure that we do not see a massive escalation in salaries.

Mr. Gareth Wardell: Does my hon. Friend agree that it is hoped that the Government will advertise all the posts that will become available on the new health authorities, including the role of chief executive, so that we can have open competition? Does he agree that no job that currently exists should be protected, but that they should all be open to anyone, whether executive or non-executive, so that we have the best people running the health authorities? Perhaps early retirement packages could be looked at soon, so that those who are reaching the stage at which they need to think about retirement can be assisted in that direction.

Mr. Ainger: I could not agree more. To illustrate my hon. Friend's point, it is interesting that, when the post of chief executive of the NHS trust in Pembrokeshire was first advertised, it referred to requiring somebody with business acumen. It did not mention health care or patients. That advertisement failed to lead to an appointment. After my intervention to point out the omissions, the post was readvertised, and included references to health care and requiring somebody with experience in the NHS. The excellent Mr. Stuart Fletcher was then appointed.

Mr. Richards: The hon. Member for Rhondda (Mr. Rogers) made the best speech that I have ever heard him make. He spoilt it by supporting the amendment at the end. I agree with his first point—

Mr. Rogers: The Minister is being very unfair.

Mr. Morgan: My hon. Friend has a majority of only 64,000.

Mr. Rogers: I wish my hon. Friend would not take the words out of my mouth. I am in such a sensitive position with my parliamentary majority that any compliments from the Minister can only put me in jeopardy.

Mr. Richards: The hon. Member for Rhondda spoke about clinical effectiveness. The Government share his view, and attach a high priority to that. There are on-going trials. The Government also agree with the hon. Gentleman's point about centralisation. I am sure that he will agree that the health service reforms have devolved power and decision making to local people. His comments about the size of the Welsh Health Common Services Authority reflect the Government's view.
The hon. Gentleman referred to standards of design. The current standards and the need to maintain standards will remain, and a capacity will be needed at the centre, either within the Welsh Health Common Services Authority or within the Welsh Office, to monitor the

projects. That will need a fairly small team, and the Welsh office will receive and consider all evaluations undertaken by trusts.
The hon. Member for Ynys Môn (Mr. Jones) gave one or two anecdotal examples of what I would call micro-level savings that might be made in Gwynedd. What we are doing with the Welsh Health Common Services Authority is on rather more of a macro-level. We are looking for greater efficiency and a better service. The hon. Gentleman made a serious point about the guarantee and continuity of supplies. It is for the customer—the trust or whoever—to ensure that continuity of supplies is maintained.
The hon. Member for Pembroke (Mr. Ainger) raised the small versus large issue. The Bill is not the end of the road, but is very much the beginning. We envisage that, over time, the purchasing role will shift more and more to GP fundholders. Decisions will therefore he made much closer to the patient than he fears would be the case with rather larger health authorities than he would wish. With regard to his point about salaries and so on, the my right hon. Friend the Secretary of State has made it clear that management costs must and should be kept under control, and, indeed, they include the salaries of senior executives within the trusts.

Mr. Morgan: I rise briefly to explain why I shall seek leave to withdraw the amendment.
The Minister mentioned, perhaps unwisely, the fact that Opposition Members supported one of the principles behind the Bill, but I do not think that he made any attempt to understand our objections. The idea of crossing the boundary between primary and secondary health care, in purchasing and commissioning—the new word, as the Government have a taboo about using the word "planning"—is one that the Minister does not seem to understand. We agree with crossing that boundary. We agree with merging family health service authorities and district health authorities, but the Government have demerged at the same time as they have merged.
They are demerging GP fundholders, who represent an ever-increasing proportion. The figure is expected to be 40 per cent. in Wales—it may be higher in England, but it is certainly less in Scotland—from April. They are being demerged from the merger. That is the problem that the Minister has not understood and which causes us difficulties. Indeed, we know from the documents that we have from his Department that it is causing the Welsh Office considerable difficulties.
How does one, having broken up Humpty-Dumpty, put him back together, when one has one created all these new animals that make their own purchasing and commissioning decisions? People have described the difficulty as one of herding cats in a thunder storm, but it was not me who said that, of course. When these alleged savings are created—I do not think that the Minister has dealt with this problem—what do we do with them?
The savings are known as "do-it-yourself top slicing". If anybody under the age of 15 is listening, it is not something that I would advise them to do at home. The Minister top-slices sums to release into waiting list initiatives or whatever, but GPs are now able to do that themselves. They can reserve money—it looks as though the figure will he £10 million in Wales and probably £200


million throughout Britain—to spend as they want, in the same way that Ministers have the right to top-slice for special ministerial initiatives.
My hon. Friend the Member for Rhondda (Mr. Rogers) attempted to solve the fundamental problem of the health service: how does one have local initiative and national guidelines? I made the point earlier about the Wrexham Maelor to Cardiff stillborn baby scandal—perhaps the Minister will refer to it with respect to the Glan Clwyd baby theft issue. We all want a local inquiry to try to solve the problem and for the Minister to say, "What lessons have we learnt from the local inquiry? Do we need national guidelines?" Perhaps he should have been a bit clearer about what lessons could be learned at an all-Wales level from those individual incidents, which teach all of us a lesson. That is the way in which one bridges the gap between the need for decisions to be taken locally, but with the right to establish national guidelines for minimum standards when required.

Mr. Rogers: Surely the lessons are immediately apparent. When the Government issue instructions to health trusts to go outside to private contractors, they must impose particular standards. That is self-evident. We do not need a massive inquiry involving hundreds of thousands of pounds. Something should be done at a local level. It is all about controlling private contractors.

Mr. Morgan: I entirely appreciate that; otherwise those scandals occur, and our functions as politicians is to slam the stable door shut with as much panache as we can, finding a new locksmith and so on, while trying to persuade the public to forget that the horses have been stolen in the first place. We are concerned that the Government are not good at listening when, if they have to listen, it cuts across the dogma.
The Minister said that he was happy with the consultation on the artificial limb and appliance service in Wales and that he will preserve necessary all-Wales services, but he will have seen the scathing letter from the British Limbless Ex-Servicemen's Association about the break-up of that service. I hope that he will reconsider the matter.
I apologise to the hon. Member for Ynys Môn (Mr. Jones) for any misunderstandings between him and me, as we are undoubtedly on the same side of the issue tonight. I am sure that we will be able to agree on any remarks that I made but which he may have misheard.
I want to know whether we received a genuine concession from the Minister on in-house bids for the Welsh Health Common Services Authority. He told me that I was wrong and that in-house bids would be allowed. I have to tell him that at a face-to-face meeting with the chairman, the chief executive, two union officials—one lay, one full-time—and several senior officials, the chairman told me that he had been instructed by the Welsh Office not to allow any in-house bids. I cannot do better than that. That is the information that I was given.

Mr. Richards: Let me make it clear to the hon. Gentleman, so that there is no misunderstanding, that no

instruction has gone from my Department to the Welsh Health Common Services Authority to exclude in-house bids.

Mr. Morgan: The authority seems to have developed the opposite impression. Perhaps I should try to clarify that, and perhaps the Minister will as well.
My hon. Friend the Member for Pembroke (Mr. Ainger) made some extremely important points about the accountability of the health service, particularly of some of the rip-roaring practices that have occurred in the pay of chief executives, their perks and early retirement. In Pembroke, what is known as Bennett's folly occurred when one of my hon. Friend's predecessors, just before an election, formed a trust because the Government were determined to have a trust in place before the election.
When the chief executive took early sick leave—I understand that he had been driving a Porsche, which had been paid for by the health authority, and he developed backache, because Porsches tend to have that effect—it is believed locally that he wrote on the application the reason for his illness as "Munchausen's syndrome by Porsche". The lesson for everybody is not to go for flashy cars if one is in a senior position in the health service.
That was symptomatic of what was going wrong with Ministers exceeding their powers, or letting their vision of a new dogmatic health service overtake sensible planning of what the people of Wales wanted. It was also one of Bennett's follies to send the Welsh Health Common Services Authority to a new, expensive skyscraper office block, which has now become the target of the next Secretary of State's desire to eliminate bureaucrats in the health service. The Minister's predecessor has two black marks against him for the problems that he has created for people working in the health service.
The predecessor before that was the Secretary of State who, of course, had all the wonderful pleasures that the present Secretary of State wants by virtue of this Bill, to decide how many health authorities there should be. His predecessor but one, Lord Crickhowell, decided that he wanted a local health authority for Pembroke and set up an additional health authority but the present Secretary of State wants to rationalise health authorities.
It must be wonderful for Secretaries of State to be able to decide how many health authorities they can have, while the House does not have a great deal of opportunity to establish proper criteria to determine how many we need in Wales. If we are really to decide how many health authorities there should be in Wales, the job should possibly be left to a Welsh Assembly after the next election.

Madam Deputy Speaker: Is the hon. Gentleman seeking leave to withdraw the amendment?

Mr. Morgan: Yes, Madam Deputy Speaker. I mentioned that earlier.

Madam Deputy Speaker: The hon. Gentleman was going to withdraw it, but did not do so.

Mr. Morgan: I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Gunnell: I beg to move amendment No. 4, in page 21, line 5, at end insert—


'5.—(1) No appointment shall be made under paragraph 1(a) or (b) above unless the Secretary of State has first procured and considered independent advice as to the suitability of the respective candidate.
(2) "Independent advice" in subparagraph (1) above means advice from a person or persons with relevant local knowledge or experience, with particular reference to the provision of health services, but who is, or who are, not—
(a) employed in any capacity by, or in any commercial or contractual relationship with, any Health Authority or NHS trust,
(b) employed by the Crown,
(c) the holder or holders of any public elected office, or
(d) affiliated to, or publicly identified with, any political party or cause.
(3) "Suitability" in subparagraph (1) above means personal qualifications or aptitude, irrespective of political affiliations, for discharging the functions of the post to which the appointment is to be made.'.
It was said earlier that we had been through some issues a number of times, and this is one such issue. We have discussed many times, and at length, the appointment of health authority members. The hon. Member for Milton Keynes, North-East (Mr. Butler) thinks that we have spent an unduly long time on such matters, and I notice that, in support of his plea, the digital clocks have broken down. It is the first time that I have seen them out of action, and it means that we cannot check whether we are talking for too long. However, it is an important issue, and it is necessary to emphasise one or two points in the context of amendment No.4.
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The amendment seeks to change the procedure for the appointment of non-executive members and chairmen of health authorities and other health bodies. The Government have already accepted that their record in this respect has been very poor. They have made grossly biased political appointments and because they now feel some guilt in the past month the Secretary of State issued a paper on the appointment of chairmen and non-executive directors to NHS authorities and trusts.
Much of the procedure is contained in the statement but not in the Bill. The Bill gives an outline but not the detail of how the appointments are to be made. The amendment seeks to add that detail to the Bill and to ensure that the system of appointments is more independent than that which the Secretary of State, to judge from her guidance notes, is trying to introduce.
From a statistical point of view, appointments made since the NHS reforms have involved those with affiliations to the Conservative party. Analysis after analysis has made that bias clear. In fact, it is unusual for that bias to be denied, and only in the Standing Committee debating the Bill have I heard vigorous denials that there were political appointments. Even in Committee, evidence was produced to show that appointments were structured to favour Conservative party members. I stress that the barrier to changing the political bias in appointments is in the guidance notes produced by the Secretary of State.
Our experience in Yorkshire shows the political nature of such appointments and, although I raised this matter in Committee, I shall do so again. I was a political appointee, albeit a Labour political one, to Leeds health authority. It might be argued that I was appointed as a member of the council, but I was appointed as a Labour member of a Labour-controlled council. Leeds Health Care, the health

authority that I joined, is, in many ways, a very good health authority. Four of its six members were clearly political appointees, if I count myself among them.
The chairman, who I believe to be a good and effective chairman, was the chairman of Yorkshire area Conservative group. One member was the ex-leader of the then Conservative-controlled city council and another was a noted Conservative business man who had previously been the chairman of one of the two Leeds health authorities when they were divided. That makes three political appointments out of four, and there were two appointments that I regarded as neutral. A university appointee became vice-chair of Leeds Health Care and a second university appointee was director of the Nuffield centre for health service studies. That meant that there were two people who may have been generally politically neutral.
The health authority made its decisions on the basis of what it considered to be best for health care in the city as a whole. I do not think that decisions were made on a political basis. The appointments were political, but the decisions were, on the whole, sensible. It was intended to reach consensus on the way in which Leeds Health Care worked.
There are still some malfunctions in the way in which our authorities work, as shown by the case concerning long-term care to which I have already referred. The health commissioner found Leeds health authority at fault, yet the case was never reported to health authority members. Although the authority was strongly criticised by the health commissioner, none of the non-executive members of Leeds Health Care—those who were privy only to what went on in board meetings—were aware of the case. I do not think that the chair of the authority was aware of it, either. With a case that gained such notoriety, it was a reflection on the way in which we were organised that a decision that strongly upset the health commissioner was never, either before or after it was seen to be a difficult case, referred to the board. That matter needs to be looked at.
In Yorkshire, although there were a number of Labour appointees, the then chair of the regional health authority made it clear to me that he was regarded as having appointed enough Labour members. When it was suggested that he might appoint another to another authority, he said that he felt that he was already somewhat suspect because most of the authorities in Yorkshire appeared to have a Labour member. As he told me, that was a contrast with what happened in other areas. If we look at the statistics as a whole, we see that the pattern in Yorkshire was not a normal pattern.
What concerns me about the pattern established for the future is that we shall continue to have political appointments despite the fact that the wording suggests otherwise. The position is made clear in the draft guidance, which says:
The aim of this guidance is to establish a national framework within which Regional Policy Board Members … can implement new procedures for the appointment of non-executive directors and chairmen to NHS authorities and trusts.
The guidance continues:
RPBMs are responsible for the integrity and effectiveness of the arrangements in their region and for making recommendations on appointments to Ministers.


As we run through the guidance, it is clear, again and again, that the decision rests with the regional policy board member. The guidance says that there will be a sifting process
conducted by a panel consisting of at least three local chairmen or non-executives … The panel may also include an independent member".
When one gets to the end of the section on procedure, it is made clear that the appointment referred to is the appointment of a regional policy board member.
The RPBM will be able to use this information"—
information about people's performance and information that has come from the independent panel—
when making his/her decision whether to recommend re-appointment to the Minister. RPBMs will retain the right to over-ride the preferences of any individual board chairmen when making recommendations.
The guidance continues:
RPBMs should consult with all local MPs on those candidates intended for nominations to Ministers as chairmen.
That is a means of ensuring that the appointments remain in the hands of the Conservative party. The regional policy board members who were appointed under the old appointment procedure—not under the guidance issued by the Secretary of State—were hand-picked members of the Conservative party, whose judgment could safely be relied on. I am sure that the Minister would tell me if he were not absolutely convinced that each appointee was a card-carrying member.
Nothing is said, of course, about what the judgment of the regional policy board members will be based on. I have already mentioned a letter that I received from a regional policy board member of the Northern and Yorkshire regional health authority. That board member attempted to consult hon. Members about an appointment to St. James's hospital trust—a critical appointment at a very important hospital. The Minister knows that it was a contentious appointment because the acting chairman, who was a Labour councillor, had extensive experience of the health service.
In telling us about the appointment, Mr. Greetham says:
David"—
that is the name of the person appointed, whom I have never met, so I am totally neutral—
has very wide management experience both in industry and in his distinguished career with the Territorial Army. I am certain that this will place him in a very strong position to lead the Trust through the challenging and changing times ahead, and I hope you will be supportive of this appointment.
We are contrasting a person with distinguished service in the Territorial Army and experience in industry with someone acting as a chair of social services, who played an active role when the widespread issue of child abuse first came to public attention and who has been a member of the health service trust since it was established at St. James's seven years ago. The latter candidate also had experience of being acting chairman for over a year.
I do not discount experience in industry, but I wonder what the Territorial Army has in common with the national health service. I have no doubt that some of my colleagues would be able to suggest a reason.

Ms Coffey: They all wear uniforms.

Mr. Gunnell: I forgot that. I know that the Territorial Army is pretty hierarchical, too.
We need a process that ensures much more genuine independence. The amendment suggests that independent advice should not be given by people who are holding office in the health authority, who are employed by Her Majesty's Government or who are the holders of any publicly elected office. They should not be political people. [Interruption.] We are suggesting that those people should not be identified with any political party. We are not suggesting that none of the appointees should have political affiliations, but we are suggesting that the independence of advice on suitability of candidates should be more genuinely independent than is suggested in the Bill or in the regulations.

Ms Coffey: I want to add a few comments to those made by my hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell), who gave a fairly comprehensive analysis of the problems. He described how the amendment would achieve some credibility in terms of the public's perception of objective criteria being used in relation to the appointments.
I would be interested to know the size of the new health authorities which will comprise the old health authorities and the FHSAs. Obviously the size of the new authorities will vary according to the existing membership. However, there will have to be a process in some areas whereby existing members will not be reappointed to the new health authorities because there will be too many members when the members of the FHSAs are added to the members of the old health authorities.
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As there is no transparent system to show how the members of those authorities were appointed in the first place, I should be interested in the explanation of why some members are not going to be reappointed to the new health authorities.
I was a member of an old district health authority. I did not sit on that authority after 1990 as elected political nominees were thrown off it. Of course, I was not a political appointee, but I was a representative of a political party. That was regarded as positive, because places were reserved for members of political parties.
I sat beside other members of the district health authority who were clearly appointed because places were reserved for particular specialities. Others were appointed by mysterious routes. The problem about appointments is not recent; it has existed for some years.
The difference between appointments to the old district health authority and the new appointments is that, in those days, no one was paid to be a member of the district health authority. People made a contribution because they were public spirited. They did that work voluntarily. With the new trusts and health authorities, there are executive and non-executive directors. That model is taken directly from private business and all the appointees are paid.
Some of the members of those authorities do not really know how they came to be appointed. One person told me that he had received a telephone call from someone who said, "You're a local business man. Would you be interested in being on this trust?" That man said, "Yes," so he knows something about his process of appointment.
People who have been appointed in that way have not answered an advertisement. They have simply been approached informally. They know that somehow they have been appointed by the Government because telephone calls from people inquiring whether they wanted to be members of trusts or health authorities clearly came from people who have the power to make such appointments. Ultimately, the appointments are made by the Government, so everyone assumes that they are Government appointments.
The problem for people appointed in that way is that they are not aware of the criteria for what they have to do. They do not know the criteria by which they were appointed. The appointments are short-term contracts. Presumably, members do not know whether they are going to be reappointed. The trouble is that that makes them less than independent. I am sure that some of them must think, ''Well, if we create too much trouble, we are not going to be reappointed by this mysterious process which appointed us in the first place. We are not here to be troublemakers."
That attitude impinges on the members' ability to be independent, particularly if they are paid. A voluntary member might think that if he was not reappointed, he could do something else, but when it is a paid occupation, the matter must be given some consideration. That may affect their attitudes and perceptions about what is happening.
The Government's view on appointments to trust boards is that trust boards—as the phrase implies—are business organisations. It is clear that they want to encourage people with business interests on to boards because they see the management of trusts essentially as a business enterprise. My hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) pointed out other difficulties, as there have not just been business appointments. I do not find it acceptable to say that a trust board is a business, and therefore we need people with business experience. But I suppose it is the logical view, if nothing else. A problem is that some appointments have been made for party political reasons.
In Committee I told the Minister that the Conservative Member who lost the Stockport seat in 1992 materialised as the chair of the Tameside trust some months later. The Minister would find it hard to convince me that that man was appointed because of his experience. I think—as do other members of the public—that it was a pay-off to him for having lost his seat. That sort of appointment brings the whole system into disrepute and makes it difficult for us to take seriously the notion of objective criteria.
Appointments to health authorities will be important because the Government cannot argue that those are business enterprises. Health authorities have a clear health commissioning role on behalf of the local population. If the Government's view is that health authorities should be responsive to local people, the people who sit on the authorities will be crucial. My experience in Stockport is that, almost without exception, the trust members came from outside the town. We shall be relying on those members of the health authority in Stockport to justify the idea of a locally responsive health service.
The attitudes and beliefs of the people who are appointed will be important. As the authority's purchasing role diminishes with the increase in GP fundholding, the strategic role which it performs will be absolutely crucial in the provision of care for the mentally ill, the mentally handicapped, the elderly and other specialities. It is important that the people on the health authority have the experience needed, and are local people. It is more important that they are seen to be appointed by a transparent system in which people can see what the criteria are and what the appointees are being asked to do, and that appointments have been made on the grounds of experience.
If we cannot get on to the authority people who can do the best job for the people of Stockport, and who are seen to be the ones who can do that, it will not only bring into disrepute the whole system but will be a great loss to Stockport. That view can be duplicated for all health authorities around the country.
It is not enough for the Minister to say that he believes that appointments should be made among people with the best experience. He should bring forward clear guidelines, and show how those guidelines are to be systematically adhered to and properly monitored. If he does not do that, there will be continual criticism that people get on to health authorities not because of experience, but because of who they know. Ultimately, that is to the good of neither the health authority nor the people it serves.

Mr. Kevin Hughes: Everybody knows that the system is based purely on patronage. The Government have tried to defuse that criticism by changing the procedure for appointments. The new system, however, is also a closed process and the changes represent little more than a sham—a con trick to make people think that things have changed.
The Government are not interested in real change or proper accountability and do not want people to see what is happening in the national health service. They do not want to be held accountable for the problems that exist in some parts of the NHS. They want to cover them up and keep them quiet. In short, they would be happy to take the advice of John Maples to have zero media coverage and keep the whole mess under wraps.
The amendment seeks to encourage the Government to introduce a truly independent element into the process, for example, community health councils. The Government's attempt at change—the new guidelines which they announced on 14 February—is no great leap for accountability, openness or democracy. The new sifting panel will consist of chairs of trusts appointed under the old system, and the regional chair will have the final say. Those people, who were all appointed under the old system, will control who enters the national health service and Ministers will still have the final say on chairs of NHS trusts. That is what we in Doncaster call the "Old Pals Act", section 1, paragraph 1.
One reason for our amendment is the fact that local people will have no opportunity to have a say. Five of the eight regional chairs are Tory supporters. A recent survey by The Independent showed that two thirds of the trust chairs examined had links with the Conservative party. That fact speaks for itself. Among them were spouses of Members of Parliament, former Tory politicians and party workers.
We need a more open and democratic system. Philip Hunt, director of the National Association of Health Authorities and Trusts, recognised that the changes made by the Government will not be enough to restore public confidence in the system. Lord Nolan seems to share that view. The amendment seeks to introduce an independent element into the system and ensure that people who are neither politicians nor civil servants, nor in health quangos, will have a say. The Secretary of State will be forced to seek advice to ensure that the candidate is the best possible person for the job.
Needless to say, when the Government decided to reform the appointments guidelines they missed the opportunity to introduce an independent element. In response to their announcement last week, Lord Nolan pointed out that an independent involvement could give the Government an opportunity
to dispel the widely held perception that so many are Conservative appointments.
The changes are an admission that the appointments system is neither fair nor open. The fact that the Government have made such a trifling change shows that they are not prepared to open up the system to greater scrutiny and independence, particularly locally. The Government have resisted almost every move to increase both democracy and accountability in the national health service. In Committee, they knocked back amendment after amendment on those issues whenever they arose. They will no doubt do the same with this amendment—I expect little better of them.
The Government have no belief in democracy in the national health service. We have realised that time and time again as they have made their reforms. No doubt the "Old Pals Act" will prevail this evening.

Mr. Malone: I am delighted, as always, to oblige the hon. Member for Doncaster, North (Mr. Hughes) by not rising to any of the invitations that he gives to accept any of the amendments that are tabled. Can I say, Madam Deputy Speaker—

Mrs. Bridget Prentice: Madam?

Mr. Malone: Mr. Deputy Speaker. My goodness, one has to be rapid in perception in the House, with the changes that take place.
Mr. Deputy Speaker, I hope that it will not be regarded as a serious discourtesy, but I wish to refer to the hon. Member for Cardiff, West (Mr. Morgan), who is not in the Chamber. I must say, in accordance with several admonitions from the Chair this afternoon, that I have not given the hon. Gentleman notice that I intended to refer to him, because I wish to make a fairly friendly comment.
When I slipped out earlier, as my hon. Friend the Parliamentary Under-Secretary of State for Wales, the hon. Member for Clwyd, North-West (Mr. Richards), was responsible for an amendment, I did not expect that, when the hon. Member for Cardiff, West had finished, I would return to the Chamber to discover that all the clocks had stopped—but, having listened to him in Committee, I was not entirely surprised.
I have listened to the debate on amendment No. 4, and several questions occur to me. First, where will that paragon of independence be found? If we took the amendment literally, it is hard to imagine who would be left to take up that important appointment. I assumed that the Opposition tabled the amendment with serious intent, and I considered whether we could accept it. I was tempted by what the hon. Member for Doncaster, North said, and I might well have been tempted to accept the amendment on behalf of the Government, had there not been several problems.
The amendment appeared to rule out anyone employed by the national health service as an independent contractor; so 830,000-odd souls in the country are ruled out by the amendment to start with. The amendment ruled out anyone with any type of contract with the NHS—whatever that means. Perhaps patients have contracts with the NHS—that is 78 per cent. of the public who visit their general practitioner. The amendment appeared to rule out any public sector employee or public office-holder and anyone who was a member of a political party—and presumably is a member of a political party—or identified with a cause. That no doubt also rules out many voluntary organisations.
Amendment No. 4 is the amendment from the planet Mars, because only someone from the planet Mars would qualify to serve as the independent assessor if that amendment were to be passed. On that substantive and important reservation, I suggest that the House should reject the amendment in any event.
My right hon. Friend the Secretary of State published new guidelines for the appointment of chairmen and non-executive directors of NHS authorities and trusts on 14 February 1995. The guidelines, which draw together examples of current best practice and appointment procedures, demonstrate the Government's commitment to a fair and open appointments system based on merit, not patronage. The implementation of those guidelines from 1 April 1996 throughout England will ensure that the NHS continues to benefit from the services of non-executives of the highest calibre.
It is an insult to all those who serve the national health service in a non-executive capacity that the Labour party continues to attack them in a way that is reprehensible and entirely without substance.
The new guidelines make it absolutely clear that all new candidates for non-executive appointments will be sifted by a panel of at least three people. Perhaps that meets the independence criterion in the Opposition amendment.
Surely the people best placed to judge whether a candidate is suited to the demands of service as a non-executive director are people already working in that sector. I object to the suggestion in the amendment that people who are meant to be independent should be cut off from the service. I should have thought that the solution to ensuring that proper appointments are made is that people who know the way in which the service works, who can bring some of their knowledge to bear, are far better suited to select people who will serve the health service as chairmen and non-executive directors. That is why the guidelines say that people chosen to serve on the sifting panels should be local health authority or trust chairmen or non-executives.
We recognise the need to avoid possible accusations of bias in the appointments system. We have said in the guidelines that members of the sifting panel must not be drawn from the same NHS health authority or trust board,


and that the panel may include an independent member. We have suggested, for example, that it might be a member of a local community health council—which no doubt would be welcomed by the Labour party—a local justice of the peace, or someone who is involved in the community. We recognise the value of the view of someone who is detached from the NHS, but who cannot be permanently detached from the NHS as the Labour party suggests in its amendment. The new guidelines establish the flexibility to meet local demands without compromising standards in the appointment process.
On this issue, the Government are adamant that the best people, chosen from the widest cross-section of the population, are serving our national health service. I know that Opposition Members like to mock them, but that does no service to those who have given voluntarily to a substantial and a good cause. I think it is disgraceful that Opposition Members continue to do that.
The amendment constitutes an absurd suggestion to introduce an independence that would detach people from the health service rather than bind them to it. The new guidelines will draw people from an even wider pool of candidates by advertisement, thereby encapsulating what is already well-established best practice. I suggest that the House reject the amendment.

Amendment negatived.

Order for Third Reading read.

The Secretary of State for Health (Mrs. Virginia Bottomley): I beg to move, That the Bill be now read the Third time.
This has been an extremely important debate, and I valued being present for Report as I was not able to serve on the Committee. It takes forward two of the Government's most important objectives for the national health service and it devolves many important responsibilities closer to patients, while ensuring that all parts of the national health service work to common standards upholding its ethos and its values.
The Bill abolishes the regional health authorities and will create a new and more effective local health authority with responsibilities across the broad sweep of health and health care. It will also make a major contribution towards our goal of a primary care-led NHS. The merger of DHAs and family health services authorities is welcomed throughout the House, and I am sure that it will lead to much greater clarity for all of our constituents—the users of the health service.
The new authorities will be in a stronger position to take an all-round view of local health needs; they will be able to secure a sensitive balance between prevention and treatment and between primary, community and hospital-based care.

Mr. Heppell: The Secretary of State has talked about the consensus in the House concerning the amalgamation of the FHSAs and the DHAs. We want to see those two authorities merged into one; however, we want it to be done in an efficient and effective way.
This is my only opportunity to ask the Secretary of State how she intends to respond to my hon. Friend the Member for Sherwood (Mr. Tipping), who wrote to her on 31 October to ask about the appointment of a new chief executive of the Health Commission. The former

chief executive of the FHSA, Mr. Tony Ruffell, was away on gardening leave. The Secretary of State replied then that he was being made redundant and that the matter was being sorted out. Apparently it was not sorted out, and my hon. Friend then asked the Prime Minister on 2 February—

Mr. Deputy Speaker (Mr. Michael Morris): Order. That really is not a Third Reading point. I call the Secretary of State.

Mrs. Bottomley: As you have said, Mr. Deputy Speaker, it is not a Third Reading point. That matter is still being investigated and I think that the individuals concerned are entitled to receive replies before I deal in the House with the issue of people's occupations.
I am very pleased that, in Committee, a number of clarifications and improvements were made to the Bill. We have been able to clarify the question of junior hospital doctors, and focus on the importance of education and training and the role of postgraduate deans. Of particular importance is the amendment that the House accepted today which requires new health authorities to secure professional advice from across the whole range of disciplines.
It is that integration of professional advice, rather than the rigid traditional structures, that will be much more effective. That process will include nurses, doctors and other health professionals, and it will give statutory backing to the commitment that I made on Second Reading that professional advice should become professional involvement.
I draw the House's attention to a recent survey carried out among local directors of public health, reported in The Guardian last week. There was much debate in Committee about the role of directors of public health.
The report showed that most of those involved see the NHS health reforms that have taken place over the past five years as having produced clear benefits in terms of improved public health. It revealed that 90 per cent. said that, since the reforms, the needs of the population were either being better met or at least that there had been no change; 91 per cent. saw benefits or at least no change from the purchaser provider system; 85 per cent. said that waiting times for in-patient treatment had improved; 65 per cent. said that hospital surroundings were better; 75 per cent. of local directors of public health thought that fundholding had improved the effectiveness of public health service or at least had led to no change. I hope that all those who feel strongly about the role of the directors of public health will at least take note of their opinions.
I remind the House that, only five years ago, we were debating the Third Reading of the National Health Service and Community Care Act 1990. Then, the Parliamentary Secretary spelled out the key issues as the need to provide better patient care, the need to continue with a NHS funded by the taxpayer, largely free at the point of delivery, the achievement of better value for money, the achievement of better choice for patients and the delegation of authority to NHS staff closer to patients. All those objectives are being achieved, and the improvements in patient care and a more flexible responsive service are at the heart of all our changes.
The Bill marks the end of a period of change and reorganisation to free the NHS better to carry out its vital task for the people of Britain. The role of GPs is vital.


They, with other members of the primary health care team, have a pivotal role in shaping the provision of services. Advances in practice should not be held back simply because they are not available everywhere at the same time.
Our policy is to level up, not down. I point out to the House—it is a very important point—that under our legislation, for the first time ever, the district director of public health will become a statutory post.
The real point about the directors is that we are devolving important responsibilities to local level, where they properly belong. Regional directors of public health will have a new and important role within the regional offices.
Apart from the clarification of the important nature of the Bill, we have learnt something else about the attitude of the Opposition. They continue to attack managers, but support bureaucracy. In Committee, they sought to amend the Bill to introduce strategic health planning authorities—a bureaucratic nightmare, a waste of money and proof of a Labour party still wedded to centralism not dynamism; to indecision not innovation and to pen pushers not patients.
In contrast, our Bill will save £150 million every year for better patient care. The Labour party's advocacy of regional bureaucracy finds few supporters elsewhere and its enthusiasm for putting councillors in charge of the NHS finds even fewer friends. The BMA has rejected local authority control, and the RCN does not want councillors in charge. Nye Bevan did not want it, and the NHS does not want it. Anyone who has worked under the tyranny of Labour-controlled local authorities knows only too well that our constituents do not wish the health service to be run in same way as Labour-controlled local authorities.
The Bill will create accountable health authorities with a job to do and the means to do it. It will reinforce our policy of allocating money to populations and not to institutions. Accountability will be strengthened through the public having access to a single body.
The new authorities will involve the public in decisions about priorities. They must take on more responsibility for explaining the key issues that the health service faces. My hon. Friends were right to focus on the quality, calibre and merit of those involved as non-executives and executives on health authorities as well as trusts.
The Bill is a sensible, timely and effective measure. It will build on the achievement of the new NHS and it will make it an even better place to respond to the changing needs of the patients. It is part of the Government's enduring, unshakeable commitment to the national health service and I commend it to the House.

Mrs. Beckett: I was a little surprised to discover that the Secretary of State intended to speak on Third Reading. As I recall, it is not customary for a Minister who has not bothered to serve on a Standing Committee to take the prime slot in the winding-up speeches. I am no longer surprised, however: it is clear that the right hon. Lady wanted to bore us with yet more of her irrelevant ranting.
It was right, however, for the Secretary of State to refer to an aspect of the Bill to which I too wish to begin by referring. Although explored in Committee, that aspect has not been discussed much on the Floor of the House. I refer to the merger of district health authorities and family health services authorities to create the new health authorities which alone will replace the existing regional authorities.
My party does not oppose the principle of such a merger; in fact, we have advocated it for some time, although we have never suggested that the merged authorities should replace the existing regions. Despite our support for the principle, however, the way in which the issue has been handled casts an interesting light on the Government's attitudes.
First, the Secretary of State indicated in her statement announcing the legislation in October 1993 that mergers between authorities would be permitted by the legislation; in fact, they are to be compulsory. Secondly, to further the programme of mergers, the Secretary of State has taken sweeping powers in the Bill—more sweeping, I understand, than those allowed by any precedent. She has done so despite the doubt that experience of the Child Support Agency must confer on precedents of this kind, and on the idea of taking all the powers in legislation and leaving all the detail to regulations.
The third revealing aspect even of this agreed element of the Bill is the way in which elements of the proposals that might arouse discussion or dissent have been withheld. I refer particularly to proposals relating to the shape and geographical spread of the new authorities. Ministers are well aware that the proposals arc likely to prove controversial: in fact, they were warned about that on Second Reading by a Conservative Member, the hon. Member for Hereford (Mr. Shepherd). I have given notice to the hon. Gentleman of my intention to quote what he said.
The hon. Gentleman expressed his strong preference, and that of his constituents, for the present structure, whereby a more local health authority—a district health authority—relates to the Department of Health via a regional authority, rather than being structured like the previous, broader health authorities that drew in other elements across the area involved.
We all know that the chances are that boundaries have been drawn up for the new authorities. Many administrators probably know what they are, but Parliament and the people will not be told until it is too late for the House to reject the Bill. The information that we lack about the new merged authorities, however, pales into insignificance in comparison with the information that we lack about the main provision of the Bill, which deals with the abolition of regional health authorities.
The Secretary of State said a moment ago that it was only five years since the last major reorganisation Bill was discussed in the House. That is true—and it was as a consequence of those changes that greater powers were given to the regional health authorities whose abolition the Secretary of State now proposes. It is perhaps in that respect particularly that the Bill reaffirms the Secretary of State's reputation as the Madame Mao of the national health service, proceeding with her continuous revolution. Every element of the Bill takes us further towards the cultural revolution of privatisation that she espouses,


concentrating power as it does with individual health businesses that have been set up to be ripe for privatisation.
The Bill will eliminate any pockets of resistance on the 14 regional authorities by abolishing them—although any lingering doubts about the need for their existence in their present form must surely be reinforced by the fact that so many of their functions are to be retained at regional level and, in the case of mental health tribunals, not just at the level of regional offices but at the level and in the structure of the existing 14 regions.
The Bill will introduce positive vetting of a small group of regional representatives, all of whom are to be hand-picked by the Secretary of State. It will extend the practice of gagging independent medical experts such as the directors of public health. Although the Secretary of State spoke warmly of their role, she knows very well that the regional directors strongly resent the loss of their independence. The Bill will also reduce the rights of medical, nursing and other groups to the degree of representation that they have enjoyed in the past.
The Secretary of State congratulated herself on giving way to our representations and on reinstating some statutory right to consultation in the Bill. Nevertheless, the Bill takes away the role that those representatives have enjoyed in similar authorities in the past. The Bill will end the collection and publication of regional statistics, other than those approved by the Secretary of State. It will concentrate power, presently dispersed through a tier of authorities, in the hands of the Secretary of State.
Just over a year ago, the British Medical Association expressed surprise and concern at the proposals, saying:
this has not been a consultation exercise in the proper sense of the word".
It said that people had
been presented with a fait accompli.
It questioned the rationale of the exercise of abolishing regions,
particularly since the increased size of the new regions will inevitably create communication difficulties which can only serve to undermine efficiency.
It is no clearer now than it was on Second Reading before Christmas why the Government have really brought forward a Bill that has such substantial and damaging effects on the structures and staff of our health service, and that creates so little benefit. It is undoubtedly true that the Bill creates the opportunity for the Secretary of State to implement one recommendation of the Maples report: to create a closed world of health care in which staff, from regional directors of public health to nurses and others working on our hospital wards, can more effectively be silenced and gagged about what is happening in the health service.
Earlier today, the Minister was sniffy about his claim that the Bill would make no real difference to the information available, but I should like to give the House examples, first, of the Department's way with statistics, and, secondly, of its way with other information. Those examples cast doubt on the Minister's assurances.
In a press release published on 13 February, the Minister publicised information about the role of junior doctors. He referred to a questionnaire that was sent to them in July last year. It asked how the new roles were affecting their work. The press release says that 17 per cent. of junior doctors felt that their hours of work had

reduced. Clearly, it did not seem pertinent to the Minister to say that that presumably meant that 83 per cent. did not feel that their hours had been reduced.
The press release draws attention to the fact 40 per cent. of junior doctors were experiencing more satisfaction in their work, which presumably means that 60 per cent. were not experiencing more satisfaction in their work. That is an interesting example of how the gloss on a piece of information can somehow subtly change its meaning.
Apart from the issue of the statistics that the Department publishes, and how they are described, there is the issue of the new open government code proposed for the national health service. A report in December drew attention to the views of the Campaign for Freedom of Information on that matter. The campaign pointed out that, if that code of practice went ahead, information that would have to be disclosed today by the Department of Health could in future be withheld by health authorities and national health service trusts.
It says that the new code
repeats the failings of the central 'open government' code, but omits its positive elements"—
if such there be. It draws attention to the fact that the code allows
all information on commercial or contractual activities to be withheld—not merely information which could prejudice such activities, as in the central government code.
Every piece of information that can be described or classified as relating to commercial or contractual activities may be withheld. In this new health service for which the Secretary of State takes such credit, just about everything comes under commercial and contractual activity.
It is almost certainly the case that the major reason for the Bill is the control of information, but is it the only reason? We can dispose of the Government's excuses without too much difficulty. They claim that the Bill has been introduced because of their pressing desire to reduce bureaucracy and to create savings.
On Friday, I received a parliamentary answer from the Department. It shows not only that the number of general and senior managers employed has soared far beyond what could be explained by the reclassifying of people as managers, but that the salary bill for such posts has gone from £156 million before the health changes to £600 million last year. Most of that burgeoning growth in numbers and costs has taken place not at regional health authority level—the Minister of State admitted today that the number of staff employed at regional level has fallen—but because of the division of trusts into individual businesses.
There is yet another reason why there is no need for us to take the Government's claims seriously. They are hellbent on introducing locally determined pay. They have been pressing the pay review body for years to accept that that is Government policy and it must be the framework within which their own recommendations are made. Introducing local pay will mean hiring a fresh army of negotiators and administrators for every single trust. The BMA estimates that introducing it for doctors alone would cost £40 million at least, which would wipe out every penny of the savings that the Government claim have inspired the Bill. So they cannot be in it for the money.
There are other potential reasons apart from secrecy. There were 14 regional health authorities with a minimum of about 140 board members. The clear pattern of the


Government's appointments is that those selected must be hand-picked Government loyalists. Perhaps there are not 140 people left in Britain who still loyally believe in the Secretary of State's health service changes.
That view is strengthened by the fact that the 14 RHA are being replaced by eight regional offices in which the voice of the people is heard through eight individuals appointed by the Secretary of State. Rumour has it that those eight will soon be six. Perhaps even they are showing dangerously independent tendencies. I wonder whether finding even six reliable followers will soon be too much for Madam Mao. How long will it be before we have a gang of four?
The other possible reason for the abolition of regional health authorities lies in the reaction of the Secretary of State's shock troops in the trusts. In the document "Managing the NHS", published by the Office of Health Economics, William Laing says:
Accountability of Trusts to central government has also been exercised through RHAs. Controversy arose because many NHS Trust chairs claimed that RHAs were attempting to exercise excessive and inappropriate control over Trust's operational activities.
Perhaps they still believe in the national health service.
Mr. Laing goes on:
The issue of who should monitor Trusts has now been resolved by the government's decision to abolish regional health authorities.
Dr. Jeremy Lee Potter—[Interruption.] Yes, the former Conservative voter, as he has said himself—recently said:
at the root of the NHS changes lies political dogma.
What really matters is where that dogma-driven change will lead. The Minister of State accused me today of claiming that the health service is being fragmented and that it is being centralised. He is correct: I did make both those claims, and both are justified. A total of 500 individual health businesses delivering health care is fragmentation by anyone's standards.
It is the framework to which those businesses relate that is the real giveaway. That framework now consists simply of area health authorities which cannot possibly come together to present an alternative strategic view as the regional health authorities used to do. Within that framework, the individual trust will concern itself solely with its own business and the individual health authority will concern itself solely with its own area. Apart from that, we shall be left with a structure about which the BMA says that, instead of a "management tier … independent of" the Executive at national level, there will be an "increase in centralised control".
In the document "Managing the New NHS" the new arrangements are described as a "single corporate structure". That structure will be without a countervailing voice, without any pretence of any democratic input, and every appointment within it will be made by and at the hands of the Secretary of State.
The Secretary of State, like the Government and like the Bill, becomes more discredited daily. We shall vote to reject the Bill tonight, and if and when the British people

are next given the opportunity, if they vote to preserve and enhance their health service, they will vote to reject this Government.

Mr. Malone: On behalf of my right hon. Friend, Madam Mao, may I present compliments to Polly Pot on the other side of the House, and make this simple point?
The Labour party has opposed a Bill that will reduce bureaucracy, and create savings that can be spent on patients. That shows precisely where the Labour party stands on the issue. It always has, and always will. The Labour party is always for the vested interests of the producer, not the consumer—the patient, whom the Bill is designed to serve. I hope that the House gives it a Third Reading tonight.

Question put, That the Bill be now read the Third time:—

The House divided: Ayes 285, Noes 243.

Division No. 81]
[10.00 pm


AYES


Ainsworth, Peter (East Surrey)
Clarke, Rt Hon Kenneth (Ru'clif)


Aitken, Rt Hon Jonathan
Clifton-Brown, Geoffrey


Alexander, Richard
Colvin, Michael


Alison, Rt Hon Michael (Selby)
Congdon, David


Allason, Rupert (Torbay)
Conway, Derek


Amess, David
Coombs, Anthony (Wyre For'st)


Arbuthnot, James
Coombs, Simon (Swindon)


Arnold, Jacques (Gravesham)
Cope, Rt Hon Sir John


Arnold, Sir Thomas (Hazel Grv)
Couchman, James


Ashby, David
Cran, James


Atkins, Robert
Currie, Mrs Edwina (S D'by'ire)


Atkinson, David (Bour'mouth E)
Curry, David (Skipton & Ripon)


Atkinson, Peter (Hexham)
Davies, Quentin (Stamford)


Baker, Rt Hon Kenneth (Mole V)
Day, Stephen


Baker, Nicholas (North Dorset)
Deva, Nirj Joseph


Baldry, Tony
Devlin, Tim


Banks, Matthew (Southport)
Dicks, Terry


Batiste, Spencer
Douglas-Hamilton, Lord James


Bellingham, Henry
Dover, Den


Bendall, Vivian
Duncan, Alan


Beresford, Sir Paul
Duncan Smith, Iain


Biffen, Rt Hon John
Dunn, Bob


Bonsor, Sir Nicholas
Durant, Sir Anthony


Booth, Hartley
Dykes, Hugh


Boswell, Tim
Eggar, Rt Hon Tim


Bottomley, Peter (Eltham)
Elletson, Harold


Bottomley, Rt Hon Virginia
Evans, David (Welwyn Hatfield)


Bowden, Sir Andrew
Evans, Jonathan (Brecon)


Bowis, John
Evans, Nigel (Ribble Valley)


Boyson, Rt Hon Sir Rhodes
Evans, Roger (Monmouth)


Brandreth, Gyles
Evennett, David


Brazier, Julian
Faber, David


Bright, Sir Graham
Fabricant, Michael


Brooke, Rt Hon Peter
Field, Barry (Isle of Wight)


Brown, M (Brigg & Cl'thorpes)
Fishburn, Dudley


Browning, Mrs Angela
Forman, Nigel


Bruce, Ian (Dorset)
Forsyth, Rt Hon Michael (Stirling)


Burns, Simon
Forth, Eric


Burt, Alistair
Fox, Dr Liam (Woodspring)


Butcher, John
Fox, Sir Marcus (Shipley)


Butler, Peter
Freeman, Rt Hon Roger


Butterfill, John
French, Douglas


Carlisle, John (Luton North)
Fry, Sir Peter


Carlisle, Sir Kenneth (Lincoln)
Gale, Roger


Carrington, Matthew
Gallie, Phil


Carttiss, Michael
Gardiner, Sir George


Cash, William
Garnier, Edward


Channon, Rt Hon Paul
Gill, Christopher


Chapman, Sydney
Gillan, Cheryl


Clappison, James
Goodlad, Rt Hon Alastair


Clark, Dr Michael (Rochford)
Goodson-Wickes, Dr Charles






Gorman, Mrs Teresa
Marshall, Sir Michael (Arundel)


Gorst, Sir John
Martin, David (Portsmouth S)


Grant, Sir A (SW Cambs)
Mates, Michael


Greenway, Harry (Ealing N)
Mawhinney, Rt Hon Dr Brian


Greenway, John (Ryedale)
Merchant, Piers


Griffiths, Peter (Portsmouth, N)
Mills, Iain


Grylls, Sir Michael
Mitchell, Andrew (Gedling)


Gummer, Rt Hon John Selwyn
Mitchell, Sir David (NW Hants)


Hague, William
Moate, Sir Roger


Hamilton, Neil (Tatton)
Monro, Sir Hector


Hampson, Dr Keith
Montgomery, Sir Fergus


Hanley, Rt Hon Jeremy
Nelson, Anthony


Hannam, Sir John
Neubert, Sir Michael


Harris, David
Newton, Rt Hon Tony


Haselhurst, Alan
Nicholls, Patrick


Hawkins, Nick
Nicholson, David (Taunton)


Hawksley, Warren
Nicholson, Emma (Devon West)


Hayes, Jerry
Norris, Steve


Heald, Oliver
Onslow, Rt Hon Sir Cranley


Heath, Rt Hon Sir Edward
Oppenheim, Phillip


Heathcoat-Amory, David
Ottaway, Richard


Hendry, Charles
Page, Richard


Hicks, Robert
Paice, James


Higgins, Rt Hon Sir Terence
Patnick, Sir Irvine


Hill, James (Southampton Test)
Patten, Rt Hon John


Hogg, Rt Hon Douglas (G'tham)
Pawsey, James


Horam, John
Peacock, Mrs Elizabeth


Hordern, Rt Hon Sir Peter
Pickles, Eric


Howard, Rt Hon Michael
Porter, Barry (Wirral S)


Howarth, Alan (Strat'rd-on-A)
Porter, David (Waveney)


Howell, Rt Hon David (G'dford)
Portillo, Rt Hon Michael


Howell, Sir Ralph (N Norfolk)
Powell, William (Corby)


Hughes, Robert G (Harrow W)
Redwood, Rt Hon John


Hunt, Sir John (Ravensbourne)
Renton, Rt Hon Tim


Hurd, Rt Hon Douglas
Richards, Rod


Jack, Michael
Riddick, Graham


Jackson, Robert (Wantage)
Rifkind, Rt Hon Malcolm


Jenkin, Bernard
Robathan, Andrew


Jessel, Toby
Robertson, Raymond (Ab'dn S)


Jones, Gwilym (Cardiff N)
Robinson, Mark (Somerton)


Jones, Robert B (W Hertfdshr)
Roe, Mrs Marion (Broxbourne)


Kellett-Bowman, Dame Elaine
Rowe, Andrew (Mid Kent)


Key, Robert
Rumbold, Rt Hon Dame Angela


Kilfedder, Sir James
Ryder, Rt Hon Richard


King, Rt Hon Tom
Sackville, Tom


Knapman, Roger
Sainsbury, Rt Hon Sir Timothy


Knight, Mrs Angela (Erewash)
Scott, Rt Hon Sir Nicholas


Knight, Greg (Derby N)
Shaw, David (Dover)


Knight, Dame Jill (Bir'm E'st'n)
Shaw, Sir Giles (Pudsey)


Knox, Sir David
Shephard, Rt Hon Gillian


Kynoch, George (Kincardine)
Shepherd, Colin (Hereford)


Lait, Mrs Jacqui
Shepherd, Richard (Aldridge)


Lang, Rt Hon Ian
Shersby, Michael


Lawrence, Sir Ivan
Skeet, Sir Trevor


Legg, Barry
Smith, Tim (Beaconsfield)


Leigh, Edward
Soames, Nicholas


Lennox-Boyd, Sir Mark
Speed, Sir Keith


Lester, Jim (Broxtowe)
Spicer, Sir James (W Dorset)


Lidington, David
Spicer, Michael (S Worcs)


Lightbown, David
Spink, Dr Robert


Lilley, Rt Hon Peter
Spring, Richard


Lloyd, Rt Hon Sir Peter (Fareham)
Sproat, Iain


Lord, Michael
Squire, Robin (Hornchurch)


Luff, Peter
Stanley, Rt Hon Sir John


Lyell, Rt Hon Sir Nicholas
Steen, Anthony


MacGregor, Rt Hon John
Stern, Michael


MacKay, Andrew
Stewart, Allan


McLoughlin, Patrick
Streeter, Gary


McNair-Wilson, Sir Patrick
Sumberg, David


Madel, Sir David
Sweeney, Walter


Maitland, Lady Olga
Sykes, John


Malone, Gerald
Tapsell, Sir Peter


Mans, Keith
Taylor, Ian (Esher)


Marland, Paul
Taylor, John M (Solihull)


Marlow, Tony
Temple-Morris, Peter


Marshall, John (Hendon S)
Thomason, Roy





Thompson, Sir Donald (C'er V)
Watts, John


Thompson, Patrick (Norwich N)
Wells, Bowen


Thornton, Sir Malcolm
Whitney, Ray


Thurnham, Peter
Whittingdale, John


Townend, John (Bridlington)
Widdecombe, Ann


Townsend, Cyril D (Bexl'yh'th)
Wiggin, Sir Jerry


Tracey, Richard
Willetts, David


Tredinnick, David
Wilshire, David


Trend Michael
Winterton, Mrs Arm (Congleton)



Winterton, Nicholas (Macc'fld)


Trotter, Neville
Wolfson, Mark


Twinn, Dr Ian
Wood, Timothy


Vaughan, Sir Gerard
Yeo, Tim


Walden, George
Young, Rt Hon Sir George


Walker, Bill (N Tayside)



Waller, Gary
Tellers for the Ayes:


Wardle, Charles (Bexhill)
Mr. Timothy Kirkhope and Mr. Michael Bates.


Waterson, Nigel





NOES


Abbott, Ms Diane
Davies, Bryan (Oldham C'tral)


Adams, Mrs Irene
Davies, Rt Hon Denzil (Llanelli)


Ainger, Nick
Davies, Ron (Caerphilly)


Allen, Graham
Davis, Terry (B'ham, H'dge H'l)


Alton, David
Denham, John


Armstrong, Hilary
Dewar, Donald


Ashton, Joe
Dixon, Don


Austin-Walker, John
Dobson, Frank


Banks, Tony (Newham NW)
Donohoe, Brian H


Barnes, Harry
Dowd, Jim


Barron, Kevin
Dunnachie, Jimmy


Battle, John
Eagle, Ms Angela


Bayley, Hugh
Eastham, Ken


Beckett, Rt Hon Margaret
Enright, Derek


Bell, Stuart
Etherington, Bill


Benn, Rt Hon Tony
Evans, John (St Helens N)


Bennett, Andrew F
Fatchett, Derek


Benton, Joe
Field, Frank (Birkenhead)


Bermingham, Gerald
Fisher, Mark


Berry, Roger
Flynn, Paul


Betts, Clive
Foster, Rt Hon Derek


Blunkett, David
Foulkes, George


Boateng, Paul
Fraser, John


Boyes, Roland
Fyfe, Maria


Bradley, Keith
Galbraith, Sam


Bray, Dr Jeremy
Galloway, George


Brown, N (N'c'tle upon Tyne E)
Gapes, Mike


Bruce, Malcolm (Gordon)
Gerrard, Neil


Burden, Richard
Gilbert, Rt Hon Dr John


Byers, Stephen
Godman, Dr Norman A


Caborn, Richard
Golding, Mrs Llin


Callaghan, Jim
Graham, Thomas


Campbell, Mrs Anne (C'bridge)
Grant, Bernie (Tottenham)


Campbell, Ronnie (Blyth V)
Griffiths, Nigel (Edinburgh S)


Campbell-Savours, D N
Griffiths, Win (Bridgend)


Caravan, Dennis
Grocott, Bruce


Cann, Jamie
Gunnell, John


Chidgey, David
Hain, Peter


Chisholm, Malcolm
Hall, Mike


Church, Judith
Hanson, David


Clapham, Michael
Harvey, Nick


Clarke, Tom (Monklands W)
Henderson, Doug


Clelland, David
Heppell, John


Clwyd, Mrs Ann
Hill, Keith (Streatham)


Coffey, Ann
Hinchliffe, David


Connarty, Michael
Hodge, Margaret


Corbett, Robin
Hoey, Kate


Cousins, Jim
Hogg, Norman (Cumbernauld)


Cox, Tom
Home Robertson, John


Cummings, John
Hood, Jimmy


Cunliffe, Lawrence
Hoon, Geoffrey


Cunningham, Jim (Covy SE)
Howarth, George (Knowsley North)


Cunningham, Rt Hon Dr John
Hoyle, Doug


Dalyell, Tam
Hughes, Kevin (Doncaster N)


Darling, Alistair
Hughes, Robert (Aberdeen N)


Davidson, Ian
Hughes, Roy (Newport E)






Hughes, Simon (Southwark)
Parry, Robert


Hutton, John
Patchett, Terry


Illsley, Eric
Pearson, Ian


Ingram, Adam
Pendry, Tom


Jackson, Glenda (H'stead)
Pickthall, Colin


Jackson, Helen (Shefld, H)
Pike, Peter L


Jamieson, David
Pope, Greg


Jones, leuan Wyn (Ynys Mon)
Powell, Ray (Ogmore)


Jones, Jon Owen (Cardiff C)
Prentice, Bridget (LeW'm E)


Jones, Lynne (B'ham S O)
Prentice, Gordon (Pendle)


Jones, Martyn (Clwyd, SW)
Prescott Rt Hon John


Jones, Nigel (Cheltenham)
Primarolo, Dawn


Jowell, Tessa
Purchase, Ken


Keen, Alan
Randal, Stuart


Kennedy, Jane (Lpool Brdgn)
Raynsford, Nick


Kilfoyle, Peter
Redmond, Martin


Lewis, Terry
Reid, Dr John


Liddell, Mrs Helen
Rendel, David


Litherland, Robert
Robertson, George (Hamilton)


Livingstone, Ken
Roche, Mrs Barbara


Lloyd, Tony (Stratford)
Rogers, Allan


Llwyd, Elfyn
Rooker, Jeff


Loyden, Eddie
Rooney, Terry


Lynne, Ms Liz
Ross, Ernie (Dundee W)


McAllion, John
Rowlands, Ted


McAvoy, Thomas
Ruddock, Joan


McCartney, Ian
Salmond, Alex


Macdonald, Calum
Sedgemore, Brian


McFall, John
Sheerman, Barry


McKelvey, William
Shore, Rt Hon Peter


Mackinlay, Andrew
Short, Clare


McMaster, Gordon
Skinner, Dennis


McNamara, Kevin
Smith, Andrew (Oxford E)


MacShane, Denis
Smith, Chris (Isfton S & F'sbury)


McWilliam, John
Smith, Llew (Blaenau Gwent)


Madden, Max
Soley, Clive


Maddock, Diana
Spearing, Nigel


Mahon, Alice
Spellar, John


Mandelson, Peter
Steinberg, Gerry


Marek, Dr John
Stevenson, George


Marshall, David (Shettleston)
Stott, Roger


Marshall, Jim (Leicester, S)
Strang, Dr. Gavin


Martin, Michael J (Springburn)
Straw, Jack


Maxton, John
Sutcliffe, Gerry


Meacher, Michael
Taylor, Mrs Ann (Dewsbury)


Meale, Alan
Timms, Stephen


Michael, Alun



Michie, Bill (Sheffield Heeley)
Tipping, Paddy


Michie, Mrs Ray (Argyll & Bute)
Touhig, Don


Milburn, Alan
Turner, Dennis


Miller, Andrew
Walker, Rt Hon Sir Harold


Mitchell, Austin (Gt Grimsby)
Walley, Joan


Moonie, Dr Lewis
Wardell, Gareth (Gower)


Morgan, Rhodri
Wareing, Robert N


Morley, Elliot
Watson, Mike


Morris, Rt Hon Alfred (Wy'nshawe)
Wicks, Malcolm


Morris, Estelle (B'ham Yardley)
Wigley, Dafydd


Morris, Rt Hon John (Aberavon)
Williams, Rt Hon Alan (Sw'n W)


Mowlam, Marjorie
Williams, Alan W (Carmarthen)


Mullin, Chris
Wilson, Brian


Murphy, Paul
Wise, Audrey


Oakes, Rt Hon Gordon
Worthington, Tony


O'Brien, Mike (N W'kshire)
Wray, Jimmy


O'Brien, William (Normanton)
Wright, Dr Tony


O'Hara, Edward



Olner, Bill
Tellers for the Noes:


ONeil, Martin
Mr. George Mudie and Mr. Eric Clarke.


Orme, Rt Hon Stanley

Question accordingly agreed to.

Bill read the Third time, and passed.

War Widows' Pensions

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Burns.]

Mr. Alfred Morris: This debate is about widows whose claim to the attention of this House is one of compelling priority. They are the widows of men who died or who gave the best years of their lives in the service of this country. They live with a sense of grievance which is shaming to us all and which, in this 50th anniversary year of victory in the second world war, the House must now urgently address.
Their plea for help is being debated today not only here but in the House of Lords. There the debate is led by the young Lord Freyberg who, although he is a Cross Bencher, I am delighted to call my noble Friend. He is strongly supported by other peers of all parties and of none.
Right hon. and hon. Members on both sides of the House will recall my last Adjournment debate on war widows' pensions as the culmination of a campaign that led in 1989 to more adequate provision for tens of thousands of pre-1973 widows. But the campaign did not achieve all our objectives. There was unfinished business of importance both to war widows and to service widows which my early-day motion 186, with backing from all parts of the House, urges the Government to tackle without further delay.
The motion was tabled at the request of the Officers Pension Society and the War Widows Association of Great Britain, strongly endorsed by all the 123 affiliates of the Confederation of British Service and Ex-Service Organisations, and by Help the Aged. Today, the early-day motion has 167 signatures in addition to the declared support of right hon. and hon. Members who, by convention, cannot sign such motions.
Some hon. Members have declined to sign the motion. They declined not because they disagree with its objectives but because they feel that early-day motions are of no importance. In my view, they are mistaken. It was the huge cross-party support for early-day motion 68 in 1989 that eventually persuaded that wily parliamentary tactician, Margaret Thatcher, as she then was, to concede the principal aim of the war widows' campaign of that year.
Moreover, those who support our further objectives but decline to sign the new early-day motion strangely imply that such parliamentarians as the hon. Member for Dorset, West (Sir J. Spicer), the right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel), my right hon. Friend the Member for Bethnal Green and Stepney (Mr. Shore) and the right hon. Member for Lagan Valley (Mr. Molyneaux), among many other senior Members of this House who are sponsoring the motion, know less than themselves about parliamentary realities.
What is it that we now seek for war and service widows? We seek, first, pensions for war widows that will be for life; secondly, the provision now of pensions for the widows of men who married them after retirement from the services; and, thirdly, an increase in the pensions of elderly service widows from one third to one half of their husbands' pensions.
In regard to the first of our aims, let me make it clear that basic provision for war widows was markedly improved by what we achieved in 1989. But there remains a cruel and indefensible anomaly. If a widow remarries, she loses all her widow's pension. Should her further marriage end in a second bereavement, or if it fails, her DSS war widow's pension cannot be restored.
Younger war widows, who have an attributable occupational pension from the Ministry of Defence, can apply for restoration, but even this is subject to a demeaning means test which 25 per cent. of applicants fail. That is why only one in 100 war widows feel that they can take the risk of remarrying. The other 99 per cent. remain on state benefits throughout their lives. They also suffer the enforced loneliness imposed upon them by regulations which are now very widely seen as anachronistic and inhumane. Should any war widow be found cohabiting, she forfeits her pension forthwith.
I want to quote Janet Cross, from Manchester, whose soldier husband Phil was killed by an IRA bomb in 1991. Janet, now 36 and struggling to bring up their two sons on her pension, told me that because she and her husband had to move home every two years there was no way she could build up a pension in a long-term job. She added:
I don't have a penny saved. If I marry again, or live with another man, I lose my pension.
Janet was speaking to me in a year when the National Association of Pension Funds has announced that 84 per cent. of widows' pensions in issue are now for life regardless of any change in status. At the same time, careful research by the Officers Pension Society into 14 pension schemes of our allies and former adversaries shows that eight of them never remove war widows' pensions on remarriage and, of the remaining six, five provide automatic restoration of her pension if a widow is bereaved again or the marriage fails.
Ministers say that this is too costly for them to contemplate, but we are already paying full pensions for 99 out of every 100 war widows. There would also be savings to the Department of Social Security vote and the taxpayer if, as the ex-service community argues, the younger war widows retain only the Ministry of Defence attributable pension, but not the DSS war widow's pension, which I am assured would be accepted as reasonable by war widows themselves.
I turn now to widows who married their service husbands after they had retired from the forces. In these cases, the marriage is termed a post-retirement marriage—PRM. The younger PRM service widows are allowed a pension from the MOD in respect of their husbands' service after 1978, but the older service widows have no such entitlement. That not only causes undoubted hardship, but often blights the final years of the service man's life.
The prospect of leaving his wife penniless is deeply worrying to the service man, but all he can do is scrimp and save until he dies. It is especially unfair to the older service man because, in the late 1970s when almost all public servants worked until they were 65, he was compulsorily retired at an earlier age and much more likely to enter into a post-retirement marriage.
The experience of Mrs. Heather Matthews is highly instructive. She does not receive a penny from the Army because her husband, the late Major-General Francis Matthews, retired just before they were married. He fought in the second world war and served until 1970.

Then he married Heather. Five years later, he had a heart attack and she nursed him until he died in 1976. She now ekes out a living at her home in Wiltshire and is "very bitter" that Britain is one of only two comparable countries to deny pensions to widows who married their husbands after they had retired from the services. She adds poignantly:
I hope something can be done for us.
The Officers Pension Society and the War Widows Association of Great Britain want the Government now to accept that a service widow who married her husband after his retirement, but before the age of 65—up to which point the ex-service man is liable to recall—and provided the marriage lasts for at least three years, should receive a pension related to her husband's service. It is important here to note that pension provision in such cases is already made in 14 of the 15 comparable allied schemes studied by the Officers Pension Society.
Here again, Ministers will point to the cost; but in a great many PRM cases the widows are on income support. That is almost twice as expensive to administer as widows' pensions and with none of the dignity of the as-of-right benefit they deserve.
I come now to service widows who are entitled to only one third of their husband's service pay on retirement. Half-rate forces family pensions were introduced in April 1973, but those who had already retired—including many who fought in the second world war—were excluded.
It may come as a shock to many Members of the House that Britain is now alone, among all the countries with which it can be compared, in paying any service widow entitled to a pension less than a half-rate pension. In the United States, the minimum figure is 55 per cent.; in Germany, 60 per cent.; in Australia and Belgium, up to 67 per cent.; and in the Netherlands, 71 per cent.
The result of our Government's policy in retaining "third-rate" widows' pensions is exemplified by the case of a widow living in Oxford whose late husband was a Fleet Air Arm pilot. He flew throughout the war and took part in the famous raid on the Tirpitz in Alten fjord. He died at 37 of a massive heart attack while still serving as a pilot, but his death was adjudged not to be attributable to service. After tax, his widow's current MOD pension is £29.06 a week; scarcely enough, perhaps, for the main course of a meal fit for the chief executive of British Gas. In a recent television interview, she said:
A half-rate pension would give me another £800 a year—which would revolutionise my life.
That is how pushed she is on her present income.
The Officers Pension Society and the War Widows Association of Great Britain ask the Government to accept that, where service men had no opportunity to buy in an entitlement to a half-rate pension, their "third-rate" widows, most of whom are between 75 and 85, should now have their pensions increased to the higher rate for the closing years of their lives.
Ministers may object that this would involve retrospection. But we all know that when it suits the Government, they do not hesitate to act retrospectively. State earnings-related pension schemes and delayed pensions for women to 65 come readily to mind. The latter is expected to save £5 billion a year, some of which will come from service widows. Compared with that £5 billion, the costs of righting the wrongs which I have described are very small change indeed.
In a moving letter to The Times on 13 February, Lord Boyd-Carpenter, a former Conservative Minister of Pensions and National Insurance, wrote that this 50th anniversary year of the ending of the wars in Europe and the far east is an especially appropriate moment to give comfort to those who suffered the loss of a husband and the end of their married life. He added:
Their numbers are with the passage of time diminishing, so the cost of a real improvement in their pensions will also diminish … An announcement of a generous increase in the awards to those who lost a husband in the War would seem to be the best way to commemorate the victory which their sacrifice helped us to achieve.
Who can gainsay the justice of that appeal?
Does the Minister refute what Lord Boyd-Carpenter says? If so, how does he respond to one of the more elderly of Britain's 28,000-plus "third-rate" widows who has written to me to say:
The Government will say yet again that there's no money left to help us. But there will be more than enough money for all the junketing that will take place. Tell them that not a single penny must be spent on that until there's some justice for us"?
While millions will celebrate the 50th anniversaries of the victories of 1945, others will still mourn the loved ones they lost, not only the widows of men who gave their lives in the second world war but the widows of those who have died on active service since then—in Korea, the Falklands, the Gulf war, Northern Ireland and elsewhere. In a leader about their plea, The Sun states today:
Both Lords and Commons will debate their shabby treatment. But words aren't enough. We need action. While we're laughing on VE Day, the widows will be crying. Brave men didn't die for that.
The vast majority of people could not agree more. Our debt to war and service widows cannot be measured in money terms, but lack of money inflicts hurtful indignities upon them. Let us, therefore, agree tonight that there is no better way of celebrating the historic victories of 1945 than by, first of all, meeting in full our debt of honour to Britain's war and service widows. If we cannot agree tonight and the battle has to go on, then go on it will, until justice is secured for them.

The Parliamentary Under-Secretary of State for Social Security (Mr. James Arbuthnot): I congratulate the right hon. Member for Manchester, Wythenshawe (Mr. Morris) on obtaining a debate on this exceptionally important subject. He has secured the support of a number of his right hon. and hon. Friends and some right hon. and hon. Conservative Members. We can all understand the right hon. Member's wish to help war and service widows. No doubt he did all that he could for them when he was Minister with special responsibility for war pensions in the Labour Administration in 1978.
Today's war widow's pension is, for most widows, worth almost £140. In real terms, that is much more than it was worth in the right hon Gentleman's day. In 1978, half the war widow's pension was taxable; today, like all benefits under the war pensions scheme, that £140 is tax-free. In 1978, there were only two allowances in respect of age—at 65 and 70; today, there are three. The two earlier ones are worth more in real terms, and a new tier was introduced in 1984 for war widows aged 80 and over. That allowance is now worth £24.40 week.
As the right hon. Gentleman said, in 1978 there was no additional provision for pre-1973 war widows. Today, all second world war widows and many others receive, on top of the basic pension, a supplementary pension worth £48.70 a week. That supplement is not only tax-free but completely disregarded for income-related benefit purposes.
The right hon. Gentleman raised a number of issues. To avoid confusion, I shall try to deal with each separately. What is being asked for today, both in the Chamber and in another place, and by means of the early-day motion to which the right honourable Gentleman referred, which has attracted much correspondence from right hon. and hon. Members on both sides of the Houses is that, first, a pre-1973 DSS war widow's pension should be for life, irrespective of remarriage. Similarly, that widow's pension, under the post-1973 Ministry of Defence armed forces pension scheme, should be for life.
Secondly, the half-rate armed forces widow's pension should be extended to widows who receive only a third-rate pension because their husband's service terminated before 31 March 1973. Thirdly, provision for occupational widows' pensions under the Ministry of Defence scheme should be extended to widows who married their late husbands after retirement from the forces, where that retirement took place before 6 April 1978.
I shall deal with pensions for life first. The DSS war widow's pension may be awarded where the late husband's death is due to any service in the armed forces. Pension provision for widows under the Ministry of Defence armed forces pension scheme is a separate matter. The scheme pays two types of widow's pension: the normal forces family pension and the enhanced pension where the late husband's death was due to service. The rationale behind the DSS pension and both the Ministry of Defence pensions is to assist with the loss of support which a widow could have expected from her late husband. Those pensions are therefore paid not as compensation for the loss of a husband but for the widow's maintenance.
As the right hon. Gentleman correctly said, the consequence of remarriage, since the lady is no longer a widow, is that the widow's pension is withdrawn under both schemes. The DSS position on that reflects what happens to the national insurance widow's pension. The Ministry of Defence position reflects that of the other public service occupational pension schemes.
As the right hon. Gentleman rightly said, on remarriage, the DSS awards a gratuity equal to a year's pension, which normally amounts to about £7,000. Should the lady unfortunately become widowed again, she will be eligible for assistance from the social security system. There is no provision, under the DSS war pensions scheme, for the restoration of a war widow's pension.
However, under the Ministry of Defence scheme and in line with the provisions of other public service occupational schemes, there is discretion to restore the pension. That discretion is normally exercised where the widow is financially worse off on second widowhood than when she was first widowed. In recent years, in 80 per cent. of claims for restoration, the pension has been restored.
The DSS war widow's pension is paid at a much higher rate than a national insurance widow's pension. Most widows receive, as I have said, almost £140 per week tax-free, which is approximately 250 per cent. more than the national insurance widow receives. In addition, a war widow is able to receive a retirement pension based on her own contributions, which could increase her income to nearly £200 a week, irrespective of any other income that she might have.
For many widows, £58.70 of a war widow's pension may be disregarded as income for the purposes of claims to income-related benefits. Widows who benefit from improvements made to the Ministry of Defence scheme from 31 March 1973 receive a basic DSS war widow's pension but in addition can also receive a Ministry of Defence pension.
Our record in this area is a good one. For example, we have improved significantly the value of the age allowances payable on top of the basic war widow's pension, we have increased from £4 to £10 a week the amount of war widow's pension that may be disregarded for income-related benefit purposes, and we introduced in April 1990 a supplementary pension of £40 a week, which will be £49.77 from next April, for those war widows whose husband's service ended before 31 March 1973; that is not only tax-free, but is completely disregarded for income-related benefit purposes.
The proposal of the right hon. Member for Wythenshawe is that all those generous pensions should be granted for life regardless of any change in marital status. He referred to the matter of cost. He is right that war widows' pensions for life could not be introduced without further cost. Almost 90,000 war widows have remarried since 1939. Although we do not know exactly how many are still living and would claim restoration of their pension, it would almost certainly be extremely expensive. For pre-1973 war widows alone, it could cost about £60 million in a full year, and that is taking into account offsets for state benefits currently in payment.
I assure the right hon. Member for Wythenshawe that we fully appreciate the sacrifice that the late husbands of those widows made on behalf of their country. That is why we have ensured that the pension provision for war widows fully recognises that sacrifice. That of course is no more than the country would expect while the state of war widowhood remains. However, to continue to pay a very preferential pension when a war widow has remarried and still has or has had the support of a second husband is neither justified nor fair to the widow who loses her national insurance widow's pension on remarriage.

Mr. Andrew Mackinlay: There appears to be some disparity with our own provision in the House. I understand that, if we pass on and our widows remarry, they can still enjoy the benefits of our parliamentary scheme.

Mr. Arbuthnot: I shall discuss that if I have some time later, but the difference that the hon. Member for Thurrock (Mr. Mackinlay) has drawn attention to stems from the fact that, when the scheme for the House was set up, the contributions were set to take into account the point that the hon. Gentleman has made.
I shall move on to those matters that relate solely to the Ministry of Defence armed forces pension scheme. The effect of accepting the changes that the right hon. Member

for Wythenshawe suggests would be to extend pension scheme improvements that were introduced in 1973 and 1978 to all widows of service men whose service ended before those dates. I should explain that it is a fundamental principle that improvements to occupational pension schemes should benefit only those serving on or after a qualifying date. There are good reasons for that.
It would be impossible on cost grounds, if for no other reason, to introduce major improvements to schemes such as that without imposing a fixed and current date from which those improvements can be made available. Even though the cost of making just one concession for the Ministry of Defence scheme might appear to be modest, the wider implications are significant. To make exceptions for that scheme in any of the ways which the right hon. Gentleman suggests can only have expensive knock-on effects for other public service pension schemes.
The first of the right hon. Gentleman's proposals under this heading is that all widows should receive a normal Ministry of Defence occupational widow's pension of at least half that of their late husbands' occupational pension. Before the introduction of improvements to the Ministry of Defence scheme from 31 March 1973, the widow received a pension at one third of the rate of her husband's pension. Those serving on or after that date were given the option of "buying in" to the new scheme and making direct contributions so that their widows could receive the half-rate pension. Each service man was given that opportunity, and many accepted it.
Clearly, the widow of a service man who did not choose to make such contributions cannot receive the enhanced pension. That is partly because it would he quite unfair on those who did pay, and partly because the normal principle for occupational pension schemes is that those retiring before the introduction of an improvement may not benefit from it. The option to "buy in" given to those still serving would in itself make it impossible, in all fairness, to extend the half-rate pension to widows whose husbands had left the service before 31 March 1973 and who had not, as a result, paid towards the improvement—indeed, they could not have done so.
I turn now to the last of the right hon. Gentleman's proposals—that a Ministry of Defence occupational pension should be available for widows who married their husbands after they had retired from the forces and where they had no service on or after 6 April 1978.
As I have said, when a person retires it is the provisions of the occupational pension scheme in force at the date of his retirement which determine his, and through him his widow's, entitlement to a pension. The Social Security Act 1975 provided that pensions should be given to those widows who married after their husbands' retirement. That improvement was introduced into public service occupational pension schemes, such as the Ministry of Defence scheme, from 6 April 1978 and those who left the forces before that date do not benefit from it. Even for those who do, because they left after that date, the post-retirement widow's pension may be calculated only on the length of service after that date.
Finally, I come to the comparisons which the right hon. Gentleman made between the DSS and MOD schemes and the schemes of other countries. It is true that, in some countries, widows' pensions are either never removed or restored on second bereavement. As far as the DSS scheme is concerned, those arrangements cannot really be considered in isolation, but have to be viewed within the


context of the general social and welfare environment of each of the countries concerned. While many countries continue or restore war widows' pensions, their original pension rates are generally lower than those in the United Kingdom. For instance, the rate of our war widow's pension is significantly higher than that of Australia, France, Spain and New Zealand.
As to the occupational pension schemes for the armed forces of other countries, again, comparisons are not valid. Apart from the different entitlement conditions that might apply, such as the level of contributions needed to qualify for a pension, different social factors will also apply in each country.
Comparison of occupational pension schemes within the United Kingdom would be more realistic, and in that

respect the MOD scheme compares well with those offered by most employers and, in particular, with those of other public service pension schemes.
As I have said, these are complicated and emotive issues, but I do not believe that there is any real justification either for providing pensions for life for the widows of men whose deaths were attributable to service, or for breaching the fundamental principle of public service pension schemes that any improvements to those schemes should not be made retrospective.

Question put and agreed to.

Adjourned accordingly at sixteen minutes to Eleven o'clock.